Prediction of 1 and 2 week nonelective hospitalization and sepsis hospitalization risk in adults.

Summary

Using 4.49 million adults across clinic, ED, and hospitalization encounters, the authors built and temporally validated models predicting 1–2 week risks of nonelective and sepsis hospitalizations. Performance peaked at AUROC 0.904 for sepsis hospitalization within two weeks of clinic visits, with actionable numbers-needed-to-evaluate.

Key Findings

• Temporal validation showed AUROC up to 0.904 for predicting sepsis hospitalization within 2 weeks of clinic visits.
• Models used 4,488,579 adults spanning 86,013,893 clinic, 6,035,296 EDTR, and 1,481,430 hospital encounters.
• At 40% sensitivity, numbers needed to evaluate ranged from 4.3 (NEH within 2 weeks of hospitalization) to 45 (sepsis hospitalization within 1 week of a clinic visit).

Clinical Implications

Health systems can integrate these models to flag high-risk patients after clinic or ED visits for proactive outreach (e.g., follow-up, diagnostics, care coordination) to prevent sepsis-related admissions.

Limitations

• Observational modeling with potential coding and measurement biases.
• Generalizability beyond the integrated health system requires external prospective validation.

Future Directions

Prospective impact evaluations (e.g., stepped-wedge trials) to test reductions in sepsis admissions; fairness audits and transportability studies across diverse health systems.