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Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes

Overview of attention for article published in Critical Care, April 2016
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (94th percentile)
  • High Attention Score compared to outputs of the same age and source (88th percentile)

Mentioned by

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74 tweeters

Citations

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60 Dimensions

Readers on

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121 Mendeley
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Title
Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes
Published in
Critical Care, April 2016
DOI 10.1186/s13054-016-1266-9
Pubmed ID
Authors

Chanu Rhee, Sameer S. Kadri, Robert L. Danner, Anthony F. Suffredini, Anthony F. Massaro, Barrett T. Kitch, Grace Lee, Michael Klompas

Abstract

Sepsis is the focus of national quality improvement programs and a recent public reporting measure from the Centers for Medicare and Medicaid Services. However, diagnosing sepsis requires interpreting nonspecific signs and can therefore be subjective. We sought to quantify interobserver variability in diagnosing sepsis. We distributed five case vignettes of patients with suspected or confirmed infection and organ dysfunction to a sample of practicing intensivists. Respondents classified cases as systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, or none of the above. Interobserver variability was calculated using Fleiss' κ for the five-level classification, and for answers dichotomized as severe sepsis/septic shock versus not-severe sepsis/septic shock and any sepsis category (sepsis, severe sepsis, or septic shock) versus not-sepsis. Ninety-four physicians completed the survey. Most respondents (88 %) identified as critical care specialists; other specialties included pulmonology (39 %), anesthesia (19 %), surgery (9 %), and emergency medicine (9 %). Respondents had been in practice for a median of 8 years, and 90 % practiced at academic hospitals. Almost all respondents (83 %) felt strongly or somewhat confident in their ability to apply the traditional consensus sepsis definitions. However, overall interrater agreement in sepsis diagnoses was poor (Fleiss' κ 0.29). When responses were dichotomized into severe sepsis/septic shock versus not-severe sepsis/septic shock or any sepsis category versus not-sepsis, agreement was still poor (Fleiss' κ 0.23 and 0.18, respectively). Seventeen percent of respondents classified one of the five cases as severe sepsis/septic shock, 27.7 % rated two cases, 33.0 % respondents rated three cases, 19.2 % rated four cases, and 3.2 % rated all five cases as severe sepsis/septic shock. Among respondents who felt strongly confident in their ability to use sepsis definitions (n = 45), agreement was no better (Fleiss' κ 0.28 for the five-category classification, and Fleiss' κ 0.21 for the dichotomized severe sepsis/septic shock classification). Cases were felt to be extremely or very realistic in 74 % of responses; only 3 % were deemed unrealistic. Diagnosing sepsis is extremely subjective and variable. Objective criteria and standardized methodology are needed to enhance consistency and comparability in sepsis research, surveillance, benchmarking, and reporting.

Twitter Demographics

The data shown below were collected from the profiles of 74 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 121 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 1 <1%
Unknown 120 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 24 20%
Other 19 16%
Student > Ph. D. Student 13 11%
Student > Bachelor 11 9%
Student > Master 10 8%
Other 28 23%
Unknown 16 13%
Readers by discipline Count As %
Medicine and Dentistry 62 51%
Nursing and Health Professions 10 8%
Computer Science 7 6%
Biochemistry, Genetics and Molecular Biology 5 4%
Agricultural and Biological Sciences 5 4%
Other 13 11%
Unknown 19 16%

Attention Score in Context

This research output has an Altmetric Attention Score of 42. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 April 2018.
All research outputs
#538,078
of 15,903,488 outputs
Outputs from Critical Care
#438
of 5,023 outputs
Outputs of similar age
#14,177
of 266,233 outputs
Outputs of similar age from Critical Care
#5
of 42 outputs
Altmetric has tracked 15,903,488 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,023 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 15.6. This one has done particularly well, scoring higher than 91% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 266,233 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 94% of its contemporaries.
We're also able to compare this research output to 42 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 88% of its contemporaries.