SCREEN

Electronic Sepsis Screening Among Patients Admitted to Hospital Wards: A Stepped-Wedge Cluster Randomized Trial

Patient / Population Intervention / Exposition Vergleich Endpunkt

In 60,055 patients admitted to 45 wards at five hospitals in Saudi Arabia, an electronic qSOFA-based sepsis alert in the medical record reduced 90-day in-hospital mortality compared with no screening (alert in silent mode).

N
60.055
Design
Stepped-wedge cluster RCT (45 wards, 5 hospitals), Saudi Arabia
Endpunkt
90-day in-hospital mortality
Relevanz
2
Ergebnis90-day in-hospital mortality aRR 0.85 (95% CI 0.77–0.93; P<.001). Lactate testing within 12 h of an alert aRR 1.30 (95% CI 1.16–1.45), IV fluid orders aRR 2.17 (95% CI 1.92–2.46); vasopressor use fell but code blue activation, kidney replacement therapy and C. difficile rose.
Arabi YM, et al. JAMA. 2025;333(9):763-773. 10.1001/jama.2024.25982
Diskussion & Kritik

The strongest randomised evidence that ward-level electronic sepsis screening saves lives, filling a gap in guidelines that recommended screening on limited evidence. A boundary case for this register: the alert is a rule-based qSOFA trigger, not a machine-learning model, so it tests the deployment pathway rather than AI. The stepped-wedge design cannot fully separate the intervention from secular trends, and the rise in code blue activation, kidney replacement therapy and C. difficile points to the cost of more aggressive treatment.