Physician recognition and documentation of sepsis. a comparison of the 2001 accp/sccm consensus conference definitions and physician documented diagnosis
Bibliographic record
Abstract
To compare cases of sepsis, severe sepsis and septic shock that were identified through a reference standard medical record review using the 2001 ACCP/SCCM consensus criteria definitions [ 1 ] versus physician documented cases. Retrospective cohort study in which the medical records of ICU patients from three tertiary care centres in Calgary, Canada from years 2009-2012 were randomly selected and linked to an administrative discharge abstract database and ICU clinical database. Patient demographics and clinical information including a diagnosis of sepsis according to a checklist following the ACCP/SCCM 2001 consensus definition criteria, as well as whether the terms, 'sepsis', 'severe sepsis' or 'septic shock' were documented in the physician progress notes (physician 'explicit stated diagnosis) in the patient chart were collected. Summary statistics, frequencies and percentages were calculated. Out of 945 ICU patient medical records reviewed, 583 patients (61.7%) were classified as having sepsis and 362 (38.3%) were classified as not having sepsis according to the 2001 ACCP/SCCM consensus definition. Of these 85 met criteria for sepsis, 195 for severe sepsis, and 303 met criteria for septic shock. According to the physician 'explicit' stated diagnosis, 382 out of 945 (40.42%) patients had one of the terms, 'sepsis', 'severe sepsis' or 'septic shock' documented in the chart. Multiple diagnosis terms were used in 52.3% of physician identified cases. Of the 583 cases identified by the consensus definition only 390 of these cases (64.6%) were documented by physicians (sepsis = 5.2%, severe sepsis = 23.8% and septic shock = 69.4%). In physician documented cases, 36.1% had mean SOFA scores >11, 63.9% had APACHE score>20 and 74.6% had a microbiologically confirmed infection. These results suggest that a diagnosis of sepsis is poorly documented in medical records which may be reflective of the ability of a physician to recognize less severe forms of sepsis. Factors affecting physician documentation and diagnosis must be further studied to understand the impact on data quality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".