Discussion
In this study, we described the test characteristics of an electronic screening tool for severe sepsis and septic shock in the ED. The electronic sepsis alert had high sensitivity and specificity and negative predictive value. The low positive predictive value probably resulted from the detection criteria used in the alert system, which did not include clinical information, such as presenting symptoms or confirmatory laboratory tests. In addition, we demonstrated that our electronic sepsis alert tool preceded ICU referral for severe sepsis or septic shock. This finding is important and would facilitate time-sensitive sepsis management and early sepsis care beginning in the ED.