Assessing The Predictive Value of Clinical Factors Used to Determine The Presence of Sepsis Causing Shock in the Emergency Department

Henning, Daniel J.; Carey, Jeremy R.; Oedorf, Kimie; Day, Danielle E.; Redfield, Colby; Huguenel, Colin J.; Roberts, Jonathan C.; Novack, Victor; Sánchez, León D.; Wolfe, Richard E.; Shapiro, Nathan I.

doi:10.1097/shk.0000000000000558

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…The study excluded patients with a documented baseline systolic blood pressure of less than 90 mm Hg, unless a 10 mm Hg decrease in systolic blood pressure occurred, and those who were discharged from the ED. 11 The second study was conducted in 2 urban, academic EDs in the US Pacific Northwest with 90 000 combined annual visits, and it retrospectively included all patients meeting severe sepsis criteria. 12 The current study leveraged the 2 original data sets to create a cohort of infected patients with at least 1 systolic blood pressure reading of less than 90 mm Hg after administration of at least 1 L of intravenous fluids documented during the ED stay.…”

Section: Methodsmentioning

confidence: 99%

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Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Murphy

Johnson

Hall

et al. 2019

American Journal of Critical Care

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Background Sepsis risk stratification tools typically predict mortality, although stays in the intensive care unit (ICU) of 24 hours or longer may be more clinically relevant for emergency department disposition. Objective To explore predictors of ICU stay of 24 hours or longer among infected, hypotensive emergency department patients. Methods A secondary analysis of 2 prospective, observational studies of adult patients with severe sepsis or an infection with a systolic blood pressure less than 90 mm Hg in 3 urban, academic emergency departments was performed. Patients with hypotension and infection were included. Patients with emergency department intubation, vasopressor administration, and/or death were excluded. The primary outcome was ICU stay of 24 hours or longer or death in less than 24 hours. Multivariable logistic regression was used to predict ICU stay of 24 hours or longer. Results Of 233 patients, 108 (46.4%) had ICU stays of 24 hours or longer. History of heart failure (odds ratio, 3.6; 95% CI, 1.5-8.3), bicarbonate level less than 20 mEq/L (odds ratio, 2.0; 95% CI, 1.1-3.8), respiratory rate greater than 20/min (odds ratio, 2.0; 95% CI, 1.1-3.7), and creatinine level greater than 2.0 mg/dL (odds ratio, 3.6; 95% CI, 1.9-6.7) were independent predictors of ICU stay of 24 hours or longer (area under curve, 0.74). The presence of 1 of these factors predicted ICU stay of 24 hours or longer (area under curve, 0.74) with 82.4% sensitivity and 49.6% specificity. Conclusions These exploratory results show that heart failure, bicarbonate level of less than 20 mEq/L, tachypnea, or creatinine level greater than 2.0 mg/dL increases the likelihood of an ICU stay of 24 hours or longer among infected, hypotensive emergency department patients.

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Section: Methodsmentioning

confidence: 99%

“…The screening and verification process has been described for both studies. 11,12 Medical history and the presence of altered mental status were manually abstracted from the hospital records by using a standard data collection form. Altered mental status included any mention in the ED record of altered mentation, confusion, or somnolence.…”

Section: E3mentioning

confidence: 99%

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Murphy

Johnson

Hall

et al. 2019

American Journal of Critical Care

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“…The importance of clinical and laboratory parameters are well established for management of septic patients [5][6][7]. Septic foci might be difficult to identify in patients who cannot cooperate due to septic encephalopathy [8].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

et al. 2021

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The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock

Henning

Carey

Oedorf

et al. 2017

Critical Care Medicine

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Assessing The Predictive Value of Clinical Factors Used to Determine The Presence of Sepsis Causing Shock in the Emergency Department

Abstract: Clinical data can predict the presence of sepsis causing shock in the ED in most patients. The remaining diagnostic uncertainty provides an opportunity for adding novel diagnostic testing.

Cited by 5 publications

References 26 publications

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock

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