AAEM26: Limitations of Sepsis Screening Algorithms Examined

Sepsis screening algorithms are widely used in emergency departments, particularly as hospitals prepare for the inclusion of SEP-1 in CMS Hospital Value-Based Purchasing. At AAEM26, a session examined limitations of commonly used screening approaches and their ability to identify high-risk patients.

John C. Perkins, Jr., MD, Associate Professor of Emergency Medicine at Virginia Tech Carilion School of Medicine and Research Institute in Roanoke, Virginia, presented “Failures of Sepsis Screening Algorithms and How to Identify Those Patients Before They Descend the Septic Spiral Staircase of Death.”

The session reviewed the use of systemic inflammatory response syndrome (SIRS) criteria as a foundation for many screening algorithms and examined evidence demonstrating limitations in sensitivity, including among patients with sepsis and organ failure. The presentation also addressed variability in performance across patient populations, noting that SIRS criteria do not account for individual factors such as age or medication use.

Using a case-based format, the session highlighted clinical scenarios in which sepsis may be underrecognized, including geriatric patients, individuals with tickborne illness, and patients with skin and soft tissue infections of the perineal region. Additional populations discussed included immunocompromised patients and those taking medications that may alter physiologic responses.

Adjunctive approaches to support earlier identification, including the use of the shock index, were also reviewed.

In a brief interview with Consultant360, Dr Perkins noted that, “the current sepsis screening algorithms used in most hospitals are inadequate as they apply a ‘one size fits all’ approach to a complex disease process.” He also noted that patients at highest risk of missed sepsis include geriatric and immunocompromised populations, as well as those taking medications that may blunt typical physiologic responses.

Learning objectives included recognizing limitations of SIRS-based screening in geriatric patients, identifying risks associated with tickborne illness, and describing adjunctive measures that may support earlier recognition.

Reference
Perkins JC Jr. Failures of sepsis screening algorithms and how to identify those patients before they descend the septic spiral staircase of death. Presented at: AAEM26 Scientific Assembly; April 14, 2026; Seattle, WA. Accessed April 14, 2026. https://aaem26.eventscribe.net/SearchByPresentation.asp?pfp=BrowsebyTitle