Prediction of Clinical Decompensation in an Obstetric Population [26L

Abstract

INTRODUCTION: Systems assessing the risk of clinical decompensation were developed with the exclusion of pregnant women. While they may identify obstetric patients at risk for severe illness or mortality, the Systemic Inflammatory Response Syndrome (SIRS) criteria may capture many pregnant women with normal physiology, reducing their predictive value. METHODS: Institutional Review Board approval was obtained for this retrospective chart review. All patients who triggered the Stop Sepsis Best Practice Advisory (BPA) at a large academic hospital between 1/1/2014 and 10/1/17 were included. Triggering parameters were identified and categorized as SIRS/sepsis, severe sepsis, septic shock, and other. Critical illness was defined as bacteremia, lactic acidosis, intensive care unit (ICU) admission, or mortality. Detailed review of the obstetric cohort included type and time of anesthesia and delivery, estimated blood loss, and presence of infection or hemorrhage. Student t-test, chi-square test, Fisher exact test, and logistic regression were used for analysis. RESULTS: 8,786 episodes were identified (169 obstetric, 8,617 hospital-wide). Obstetric patients vs. the hospital-wide groups were significantly more likely to trigger the BPA with systolic BP 90 bpm (98% vs 88%), and oxygen saturation <90% (25.4% v 16%). Obstetric patients were less likely to trigger due to sepsis (39% vs 53%) and had more false positives (51% vs 5%). 69% of the hospital-wide cohort and 8% of the obstetric cohort were critically ill (P<.0001). CONCLUSION: Application of SIRS criteria to obstetric patients leads to a high false positive rate. Modified parameters and “lock-out” periods surrounding anesthetic administration and delivery could improve the prediction of clinical decompensation.