Impact of manual sepsis screening in hospitalized adult patients: A systematic review.

Abstract

Manual sepsis screening, which includes bedside clinical assessment, is widely used in emergency departments and hospital wards and may improve early recognition and treatment. To synthesize evidence on the impact of manual sepsis screening on sepsis-related processes of care and mortality. We performed a systematic search of MEDLINE, Cochrane, Embase, and CINAHL for original research published between January 1, 2000 and July 31, 2024. Search terms addressed sepsis, screening, and hospital settings (emergency department, ward, intensive care unit). We included full-text studies evaluating the impact of manual screening on sepsis-related processes of care or mortality. Two reviewers screened studies, and risk of bias was assessed using the ROBINS-I tool. Of 10,469 studies identified, 17 met inclusion criteria. Studies were conducted in nine countries; most were single-center (n = 15), used pre-post designs (n = 15), and were conducted before 2016 (n = 11). Seven of 10 studies reported improvement in at least one process-of-care outcome after implementation. Six of 13 studies reported statistically significant mortality reductions; three additional studies reported ≥5% absolute mortality improvement without statistical testing or significance. Overall conclusions were limited by high risk of bias, primarily due to confounding. Evidence supporting manual sepsis screening is low quality and may be outdated given evolving sepsis recognition and care. Rigorous contemporary studies are needed to guide adoption and implementation decisions.