Derivation and Validation of Predictive Factors for Clinical Deterioration after Admission in Emergency Department Patients Presenting with Abnormal Vital Signs Without Shock

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

doi:10.5811/westjem.2015.9.27348

Cited by 12 publications

(8 citation statements)

References 25 publications

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“…Prior studies have established the clinical utility of using lactate concentration in patients with a variety of critical illnesses [ 2 , 5 , 6 , 11 – 14 , 19 ]. For instance, Shapiro et al showed that in ED patients with infection, the 28-day in hospital mortality rate was 28% if a single lactate was > 4 mmol/L, 9% if it was 2.5 to 4, and 4.9% if lactate levels were normal.…”

Section: Discussionmentioning

confidence: 99%

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Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection

Oedorf

Day

Lior

et al. 2017

WestJEM

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IntroductionLactate levels are increasingly used to risk stratify emergency department (ED) patients with and without infection. Whether a serum lactate provides similar prognostic value across diseases is not fully elucidated. This study assesses the prognostic value of serum lactate in ED patients with and without infection to both report and compare relative predictive value across etiologies.MethodsWe conducted a prospective, observational study of ED patients displaying abnormal vital signs (AVS) (heart rate ≥130 bpm, respiratory rate ≥24 bpm, shock index ≥1, and/or systolic blood pressure <90 mmHg). The primary outcome, deterioration, was a composite of acute renal failure, non-elective intubation, vasopressor administration or in-hospital mortality.ResultsOf the 1,152 patients with AVS who were screened, 488 patients met the current study criteria: 34% deteriorated and 12.5% died. The deterioration rate was 88/342 (26%, 95% CI: 21 – 30%) for lactate < 2.5 mmol/L, 47/90 (52%, 42 – 63%) for lactate 2.5 – 4.0 mmol/L, and 33/46 (72%, 59 – 85%) for lactate >4.0mmol/L. Trended stratified lactate levels were associated with deterioration for both infected (p<0.01) and non-infected (p<0.01) patients. In the logistic regression models, lactate > 4mmol/L was an independent predictor of deterioration for patients with infection (OR 4.8, 95% CI: 1.7 – 14.1) and without infection (OR 4.4, 1.7 – 11.5).ConclusionLactate levels can risk stratify patients with AVS who have increased risk of adverse outcomes regardless of infection status.

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Section: Discussionmentioning

confidence: 99%

“…We enrolled patients with AVS to target an “at risk” population. 19 Patients were enrolled from November 11, 2012, to January 31, 2013. The study was conducted at an urban, academic, tertiary care hospital with 55,000 annual ED visits.…”

Section: Methodsmentioning

confidence: 99%

Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection

Oedorf

Day

Lior

et al. 2017

WestJEM

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“…This can have serious implications for patient outcomes. Strategies to ensure good CCDS system usability include incorporating human factor design elements, integrating CCDS system sepsis workflows into current medical emergency clinical pathways, and linking CCDS systems with existing clinical deterioration policies [ 42 , 178 - 180 ]. Only 11.3% (14/124) of the studies we investigated included usability outcomes, with only 14% (2/14) of these studies [ 70 , 93 ] evaluating alert fatigue.…”

Section: Discussionmentioning

confidence: 99%

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review

Ackermann¹,

Baker²,

Green³

et al. 2022

J Med Internet Res

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Background Sepsis is a significant cause of morbidity and mortality worldwide. Early detection of sepsis followed promptly by treatment initiation improves patient outcomes and saves lives. Hospitals are increasingly using computerized clinical decision support (CCDS) systems for the rapid identification of adult patients with sepsis. Objective This scoping review aims to systematically describe studies reporting on the use and evaluation of CCDS systems for the early detection of adult inpatients with sepsis. Methods The protocol for this scoping review was previously published. A total of 10 electronic databases (MEDLINE, Embase, CINAHL, the Cochrane database, LILACS [Latin American and Caribbean Health Sciences Literature], Scopus, Web of Science, OpenGrey, ClinicalTrials.gov, and PQDT [ProQuest Dissertations and Theses]) were comprehensively searched using terms for sepsis, CCDS, and detection to identify relevant studies. Title, abstract, and full-text screening were performed by 2 independent reviewers using predefined eligibility criteria. Data charting was performed by 1 reviewer with a second reviewer checking a random sample of studies. Any disagreements were discussed with input from a third reviewer. In this review, we present the results for adult inpatients, including studies that do not specify patient age. Results A search of the electronic databases retrieved 12,139 studies following duplicate removal. We identified 124 studies for inclusion after title, abstract, full-text screening, and hand searching were complete. Nearly all studies (121/124, 97.6%) were published after 2009. Half of the studies were journal articles (65/124, 52.4%), and the remainder were conference abstracts (54/124, 43.5%) and theses (5/124, 4%). Most studies used a single cohort (54/124, 43.5%) or before-after (42/124, 33.9%) approach. Across all 124 included studies, patient outcomes were the most frequently reported outcomes (107/124, 86.3%), followed by sepsis treatment and management (75/124, 60.5%), CCDS usability (14/124, 11.3%), and cost outcomes (9/124, 7.3%). For sepsis identification, the systemic inflammatory response syndrome criteria were the most commonly used, alone (50/124, 40.3%), combined with organ dysfunction (28/124, 22.6%), or combined with other criteria (23/124, 18.5%). Over half of the CCDS systems (68/124, 54.8%) were implemented alongside other sepsis-related interventions. Conclusions The current body of literature investigating the implementation of CCDS systems for the early detection of adult inpatients with sepsis is extremely diverse. There is substantial variability in study design, CCDS criteria and characteristics, and outcomes measured across the identified literature. Future research on CCDS system usability, cost, and impact on sepsis morbidity is needed. International Registered Report Identifier (IRRID) RR2-10.2196/24899

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“…This suggests a need to incorporate additional factors in any predictive algorithm. Age, serum bicarbonate, and lactic acid have separately been shown to be associated with inpatient deterioration 11…”

Section: Discussionmentioning

confidence: 99%

Association of Vital Signs and Process Outcomes in Emergency Department Patients

Hodgson

Poterack

et al. 2019

WestJEM

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Introduction We sought to determine the association of abnormal vital signs with emergency department (ED) process outcomes in both discharged and admitted patients. Methods We performed a retrospective review of five years of operational data at a single site. We identified all visits for patients 18 and older who were discharged home without ancillary services, and separately identified all visits for patients admitted to a floor (ward) bed. We assessed two process outcomes for discharged visits (returns to the ED within 72 hours and returns to the ED within 72 hours resulting in admission) and two process outcomes for admitted patients (transfer to a higher level of care [intermediate care or intensive care] within either six hours or 24 hours of arrival to floor). Last-recorded ED vital signs were obtained for all patients. We report rates of abnormal vital signs in each group, as well as the relative risk of meeting a process outcome for each individual vital sign abnormality. Results Patients with tachycardia, tachypnea, or fever more commonly experienced all measured process outcomes compared to patients without these abnormal vitals; admitted hypotensive patients more frequently required transfer to a higher level of care within 24 hours. Conclusion In a single facility, patients with abnormal last-recorded ED vital signs experienced more undesirable process outcomes than patients with normal vitals. Vital sign abnormalities may serve as a useful signal in outcome forecasting.

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Derivation and Validation of Predictive Factors for Clinical Deterioration after Admission in Emergency Department Patients Presenting with Abnormal Vital Signs Without Shock

Cited by 12 publications

References 25 publications

Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection

Serum Lactate Predicts Adverse Outcomes in Emergency Department Patients With and Without Infection

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Adult Inpatients: Scoping Review

Association of Vital Signs and Process Outcomes in Emergency Department Patients

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