- Design
- Retrospective multicentre diagnostic accuracy cohort
- Population
- 166,943 paediatric visits to 8 emergency departments in New York
- Primary outcome
- Sepsis (Phoenix score ≥2) within 24 hours of arrival
- Effect
- Sensitivity 36% (29 to 43%); PPV 3%; under-5s 20%
An independent evaluation tested a sepsis early-warning model built into a widely used electronic record system across eight New York emergency departments. Among 166,943 paediatric visits, 189 children met Phoenix criteria for sepsis within 24 hours.
The alert's sensitivity was 36% (95% CI 29 to 43%) and its positive predictive value 3%; it fired before sepsis onset in only 30%. Sensitivity was lower still in children under five (20%), in Black children (22%) and in departments outside tertiary children's hospitals (25%).
A tool that misses two-thirds of cases while most of its alerts are false positives gives false reassurance in exactly the setting where clinicians are busiest. The lesson travels to any automated alert: check how it performs locally before relying on it.
- Do not treat a silent sepsis alert as evidence that a child is not septic
- Rely on clinical assessment, repeated observations and parental concern in febrile children
- Be most cautious in under-fives, where the alert performed worst
- Ask for local validation data before any automated sepsis tool is switched on
Why it matters
Electronic alerts can create false reassurance precisely where vigilance matters most.
Don't overread it
This tested one commercial model in one health system; other tools may perform differently.
The statistics, in plain English
Sensitivity of 36% means the alert flagged about one in three children who had sepsis. A positive predictive value of 3% means 97 in every 100 alerts were for children who did not.
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