1414: EMERGENCY DEPARTMENT TELEMEDICINE IS USED FOR PATIENTS WITH MORE SEVERE SEPSIS IN RURAL HOSPITALS

AbstractThis study was designed to develop and validate an early warning system for sepsis based on a predictive model of critical decompensation. Data from the electronic medical records for 537,837 visits to a pediatric Emergency Department (ED) from March 2013 to December 2019 were collected. A multiclass stochastic gradient boosting model was built to identify early warning signs associated with death, severe sepsis, non-severe sepsis, and bacteremia. Model features included triage vital signs, previous diagnoses, medications, and healthcare utilizations within 6 months of the index ED visit. There were 483 patients who had severe sepsis and/or died, 1102 had non-severe sepsis, 1103 had positive bacteremia tests, and the remaining had none of the events. The most important predictors were age, heart rate, length of stay of previous hospitalizations, temperature, systolic blood pressure, and prior sepsis. The one-versus-all area under the receiver operator characteristic curve (AUROC) were 0.979 (0.967, 0.991), 0.990 (0.985, 0.995), 0.976 (0.972, 0.981), and 0.968 (0.962, 0.974) for death, severe sepsis, non-severe sepsis, and bacteremia without sepsis respectively. The multi-class macro average AUROC and area under the precision recall curve were 0.977 and 0.316 respectively. The study findings were used to develop an automated early warning decision tool for sepsis. Implementation of this model in pediatric EDs will allow sepsis-related critical decompensation to be predicted accurately after a few seconds of triage.

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Comparison of six scoring systems for predicting the mortality of severe sepsis patients in the emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2017.09.048 ◽

2018 ◽

Vol 36 (5) ◽

pp. 902-904 ◽

Cited By ~ 2

Author(s):

Si-jia Liu ◽

Hai Hu

Keyword(s):

Emergency Department ◽

Severe Sepsis ◽

Scoring Systems

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Etiology of Illness in Patients with Severe Sepsis Admitted to the Hospital from the Emergency Department

Yearbook of Critical Care Medicine ◽

10.1016/j.yccm.2010.12.009 ◽

2011 ◽

Vol 2011 ◽

pp. 183-184

Author(s):

S.L. Zanotti-Cavazzoni

Keyword(s):

Emergency Department ◽

Severe Sepsis

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EVALUATION OF APACHE II, SAPS II, MPM II, AND MEDS FOR THE PROGNOSTICATION OF SEVERE SEPSIS OR SEPTIC SHOCK IN THE EMERGENCY DEPARTMENT.

Critical Care Medicine ◽

10.1097/00003246-200612002-00007 ◽

2006 ◽

Vol 34 ◽

pp. A2 ◽

Cited By ~ 1

Author(s):

Thomas Cho ◽

H Bryant Nguyen ◽

Sean R Hayes ◽

Laura Leistiko ◽

Renee Schroetlin ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Severe Sepsis ◽

Apache Ii ◽

Saps Ii

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Differences in Hypotensive vs. Non-Hypotensive Sepsis Management in the Emergency Department: Door-to-Antibiotic Time Impact on Sepsis Survival

Medical Sciences ◽

10.3390/medsci6040091 ◽

2018 ◽

Vol 6 (4) ◽

pp. 91

Author(s):

Leonor Ballester ◽

Rafael Martínez ◽

Juan Méndez ◽

Gloria Miró ◽

Manel Solsona ◽

...

Keyword(s):

Emergency Department ◽

Severe Sepsis ◽

Clinical Laboratory ◽

University Hospital ◽

Antibiotic Administration ◽

Process Of Care ◽

Sepsis Management ◽

Initial Management ◽

Sepsis Diagnosis ◽

Community Onset

Background: Sepsis diagnosis can be incorrectly associated with the presence of hypotension during an infection, so the detection and management of non-hypotensive sepsis can be delayed. We aimed to evaluate how the presence or absence of hypotension, on admission at the emergency department, affects the initial management and outcomes of patients with community-onset severe sepsis. Methods: Demographic, clinical, laboratory, process of care, and outcome variables were recorded for all patients, at the emergency department of our university hospital, who presented with community-onset severe sepsis, between 1 March and 31 August in three consecutive years. Patient management consisted of standardized bundled care with five measures: Detection, blood cultures and empirical antibiotics, oxygen supplementation and fluid resuscitation (if needed), clinical monitoring, and noradrenalin administration (if needed). We compared all variables between patients who had hypotension (mean arterial pressure <65 mmHg), on admission to the emergency department, and those who did not. Results: We identified 153 episodes (84 (54.5%) men; mean age 73.6 ± 1.2; mean Sequential Organ Failure Assessment (SOFA) score 4.9 ± 2.7, and 41.2% hospital mortality). Hypotension was present on admission to the emergency department in 57 patients (37.2%). Hemodynamic treatment was applied earlier in patients who presented hypotension initially. Antibiotics were administered 48 min later in non-hypotensive sepsis (p = 0.08). A higher proportion of patients without initial hypotension required admission to the intensive care unit (ICU) (43.1% for patients initially hypotensive vs. 56.9% in those initially non-hypotensive, p < 0.05). Initial hypotension was not associated with mortality. A delay in door-to-antibiotic administration time was associated with mortality [OR 1.150, 95%CI: 1.043–1.268). Conclusions: Initial management of patients with community-onset severe sepsis differed according to their clinical presentation. Initial hypotension was associated with early hemodynamic management and less ICU requirement. A non-significant delay was observed in the administration of antibiotics to initially non-hypotensive patients. The time of door-to-antibiotic administration was related to mortality.

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A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

Nepal Medical Journal ◽

10.37080/nmj.68 ◽

2019 ◽

Vol 2 (2) ◽

pp. 37-42

Author(s):

Manish Nath Pant ◽

Subash Dawadi ◽

Ashish Thapa

Keyword(s):

Emergency Department ◽

Heart Rate ◽

Severe Sepsis ◽

Early Diagnosis ◽

Blood Lactate ◽

Lactate Level ◽

Tertiary Care ◽

Serum Lactate ◽

Shock Index ◽

Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4. Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

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