JMIR Publications

ABSTRACT

Background:

Sepsis is a major global health problem that leads to substantial morbidity and mortality in children, with a disproportionate impact in low-resource settings. Accurate and timely identification of children with sepsis is critical to improving clinical outcomes. The Phoenix criteria for sepsis and septic shock were developed by an international task force to identify children with sepsis. The Phoenix criteria are based on the new Phoenix Sepsis Score (PSS). Clinical decision support (CDS) tools, including mobile applications, can improve clinical decision-making by providing health workers the information they need as they care for patients.

Objective:

To develop mobile and web-based calculators for the PSS designed for use in both high- and low-resource settings.

Methods:

We developed the PSS Calculator application as a website, Android app, and iOS app using infrastructure to support a wide range of devices with one code base. To ensure accuracy, we wrote 711 unit tests for score calculation using diverse cases from the international dataset. We also conducted a usability heuristic evaluation on the app design, assessing it against the 10 general principles for interaction design. The website and Android app were released for feedback to a convenience sample of clinicians across high- and low-resource settings. Feedback was collected on a Google form linked from within the app and in communications from the users. The app was developed and tested for functionality in English and Spanish. The study was exempt by policy of our institution’s IRB.

Results:

Unit testing identified problems with the score calculation and the heuristic evaluation revealed 5 issues relevant to 6 of interaction design principles. Improvements were made to address these issues. The PSS calculator was shared with 19 clinicians from 6 countries, who were asked to give their feedback, comments, issues, and any bug reports. We addressed these issues prior to public release of the Android and iOS apps.

Conclusions:

The PSS Calculator mobile application has the potential to increase the use of the new criteria for sepsis in children in English- and Spanish-speaking global clinical settings. Potential uses include screening, research cohort identification, tracking patient trajectory, and education. Future work is needed to assess acceptance by clinicians and the clinical effectiveness of this application in global settings.