--- title: "Performance of Sepsis Screening Delivery Admissions | Sutter Health" description: "Performance Characteristics of Sepsis Screening Tools During Delivery Admissions" url: "https://www.sutterhealth.org/research/publications/performance-of-sepsis-screening-delivery-admissions-1055312694" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Performance of Sepsis Screening Delivery Admissions # Performance Characteristics of Sepsis Screening Tools During Delivery Admissions Main EK, Fuller M, Kovacheva VP, & et al. Performance Characteristics of Sepsis Screening Tools During Delivery Admissions _Obstet Gynecol. Published online December 12_ _2023\. doi:10.1097/AOG.0000000000005477_ 2023-12-12 ## Abstract Objective:To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. Methods:This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients. Results:Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC. Conclusion:During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis-endometritis. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/38086055/) ![Sylvia Sudat, Ph.D.](https://dyn.mktgcdn.com/p/2AHRaDJwevdbwzC2ecrwY3nYIxbiqxd9NbpxBlI8Kpk/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Sylvia Sudat, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/sylvia-sudat-phd-1049681027) ## Research topics - [Maternal and Infant Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Maternal+and+Infant+Health%5C%22%22) - [Obstetrics and Gynecology](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Obstetrics+and+Gynecology%5C%22%22) - [Women's Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Women%27s+Health%5C%22%22) - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions](https://www.sutterhealth.org/research/publications/performance-sepsis-screening-antepartum-postpartum-1055312962) Bauer ME, Fuller M, Kovacheva V, et al. Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions. Obstet Gynecol. Published online December 12 2023\. doi:10.1097/AOG.0000000000005480 2023 Dec 12 - Publication ### [Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome: an analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan.](https://www.sutterhealth.org/research/publications/one-blastocyst-transfer-matern-infant-outcome-1055312440) Ishihara O, Araki R, Kuwahara A, Itakura A, Saito H, Adamson GD. Fertil Steril. 101(1):128-33. doi: 10.1016/j.fertnstert.2013.09.025. Epub 2013 Oct 23. 2014 Jan 01 - Publication ### [The International Glossary on Infertility and Fertility Care, 2017.](https://www.sutterhealth.org/research/publications/internatl-glossary-infertility-fertility-care-1055312335) Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, Rienzi L, Sunde A, Schmidt L, Cooke ID, Simpson JL, van der Poel S. Fertil Steril. pii: S0015-0282(17)30429-6. doi: 10.1016/j.fertnstert.2017.06.005. \[Epub ahead of print\] 2017 Jul 28 - Publication ### [An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis.](https://www.sutterhealth.org/research/publications/surgical-vs-clinical-dx-of-endometriosis-1055312364) Taylor HS, Adamson GD, Diamond MP, Goldstein SR, Horne AW, Missmer SA, Snabes MC, Surrey E, Taylor RN. Int J Gynaecol Obstet. 2018 May 5. doi: 10.1002/ijgo.12521. \[Epub ahead of print\] Review. 2018 May 05 - Publication ### [Revisiting the Table 2 fallacy: A motivating example examining preeclampsia and preterm birth.](https://www.sutterhealth.org/research/publications/revisit-table-2-fallacy-preeclampsia-and-preterm-birth-1055312379) Bandoli G, Palmsten K, Chambers CD, Jelliffe-Pawlowski LL, Baer RJ, Thompson CA. Paediatr Perinat Epidemiol. doi: 10.1111/ppe.12474. \[Epub ahead of print\] 2018 May 21 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/performance-of-sepsis-screening-delivery-admissions-1055312694#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Performance of Sepsis Screening Delivery Admissions"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/performance-of-sepsis-screening-delivery-admissions-1055312694#medicalscholarlyarticle","name":"Performance Characteristics of Sepsis Screening Tools During Delivery Admissions","headline":"Performance of Sepsis Screening Delivery Admissions","abstract":"Objective:To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. Methods:This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients. Results:Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC. Conclusion:During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. 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