The use of telehealth in sepsis care: a scoping and systematic review and meta-analysis

Abstract

RATIONALE: Sepsis is associated with significant morbidity and mortality. Telehealth has been proposed as one strategy to improve the quality of early sepsis care, but the use and impact of telehealth applications for sepsis remain unclear. We performed a scoping review and meta-analysis to describe the types of telehealth interventions that have been used to facilitate sepsis care and to summarize the reported effect of telehealth on sepsis outcomes. METHODS: With assistance from a trained medical librarian, we identified articles reporting telehealth use for sepsis using an English-language search of PubMed, CINAHL Plus (EBSCO), Academic Search Ultimate (EBSCO), APA PsycINFO (EBSCO), Public Health (ProQuest), and Web of Science databases with no restrictions on publication date. Included studies met the following criteria: 1) use of telehealth as an intervention, 2) sepsis was diagnosed and/or treated using telehealth, 3) Surveillance for the presence of sepsis was included if it was paired with telehealth, 4) the paper was original comparative effectiveness research with a control group. Grey literature was searched in TRIP database, BASE Search Engine, and MedRxiv. Google Scholar and references in these articles were reviewed for additional studies. The meeting proceedings of the Society of Critical Care Medicine and American Telemedicine Association were reviewed over 2017-2022. Two investigators independently selected articles for inclusion and abstracted data following PRISMA guidelines. We conducted a meta-analysis on clinical outcomes reported in at least four studies, which we observed for three outcomes: survival, Surviving Sepsis Campaign bundle adherence, and antibiotic timeliness. RESULTS: A total of 15 studies were included, involving 188,022 patients with sepsis. Most (n=13) studies used observational study designs, and the most common telehealth applications were provider-to-provider telehealth consultation and intensive care unit telehealth (tele-ICU). Telehealth use was associated with higher survival (adjusted odds ratio [aOR] 1.81, 95% CI 1.12-2.93; I2 =83%), but was not associated with significantly improved 3-hour sepsis bundle adherence (aOR 1.63, 95% CI 0.61-4.40, I2 =73%) or antibiotic timeliness (aOR 1.50, 95% CI, 0.75-2.98, I2 =67%). Telehealth was most strongly associated with improved survival in settings with low control group survival (meta-regression β 0.18 lower log-odds survival per 10% increase in control group survival, 95% CI-0.12 to -0.24). CONCLUSIONS: Telehealth has been used in diverse applications for sepsis care, and pooled survival was higher in cases where telehealth was used. Additional interventional trials and cost-based analyses would clarify the causal role of telehealth in improving sepsis outcomes.