scholarly journals Sepsis Awareness at the University Hospital Level: A Survey-Based Cross-Sectional Study

2021 ◽  
Author(s):  
Jean Regina ◽  
Marie-Annick Le Pogam ◽  
Tapio Niemi ◽  
Rachid Akrour ◽  
Santino Pepe ◽  
...  
Keyword(s):  
Organ Failure ◽  
Participation Rate ◽  
University Hospital ◽  
Consensus Definition ◽  
Sepsis Management ◽  
Suspected Sepsis ◽  
Cross Sectional ◽  
Failure Assessment ◽  
Nurses And Physicians ◽  
Qsofa Score

Abstract Background: Sepsis is a leading cause of morbidity and mortality. Prompt recognition and management are critical to improved outcomes. In 2019, the Lausanne University Hospital (LUH) launched a quality of care project aiming to improve sepsis management. As part of this effort, we aimed to assess sepsis awareness among nurses and physicians of the LUH and among the local paramedics. Methods: We conducted a survey on nurses and physicians at our institution and local paramedics between January and October 2020 representing over 1,000 professionals distributed over all hospital departments. The survey assessed professionals’ knowledge of sepsis epidemiology, definition, recognition and initial evaluation (nurses and paramedics) or sepsis epidemiology, diagnosis, and management (physicians). Pediatrics and the neonatal unit were excluded. Results: A total of 1,116 of 1,216 contacted persons among the 4417 targeted population participated and completed the survey (participation rate 91.8%). This included 619 of 2,463 (25.1%) of hospital nurses, 348 of 1,664 (20.9 %) of physicians and 149 of 290 (51.4%) of canton paramedics. Our nurse and physician sample was slightly imbalanced for sex and age. Thirteen percent of participants (28.4% of physicians, 5.9% of nurses, 6.8% of paramedics) correctly identified the Sepsis-3 consensus definition. Similarly, 48.6% of physicians and 10.0% of nurses identified the SOFA (sequential organ failure assessment) score as a sepsis defining score for infected patients. Furthermore, 24% of participants identified the Quick Sepsis-related Organ Failure Assessment (qSOFA) score as a predictor of increased mortality; 6% identified correctly the components of the score. For a patient with suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively identified blood cultures, broad-spectrum antibiotics and fluid resuscitation as required interventions; 76.4% and 18.2% of physicians requested these initial measures within 1 and 3 hours, respectively. For physicians, recent training correlated with awareness regarding definitions, SOFA score and qSOFA score use and components: ORs (95%CI) 2.2 (1.4-3.6), 4.3 (2.7-6.7), 3.4 (2.2-5.2), and 2.6 (1.5-4.6), respectively).Conclusions: We identify a deficit of awareness among physicians, nurses and paramedics at LUH correlating with a lack of sepsis-specific training. Enhanced sepsis-specific educational efforts could significantly improve early identification and treatment of affected patients.

scholarly journals The Quick Sequential Organ Failure Assessment (qSOFA) Score is a Poor Mortality Predictor in Patients with Complicated Intra-abdominal Infections

2020 ◽  
Vol 8 (B) ◽  
pp. 221-225
Author(s):  
Evgeni Dimitrov ◽  
Georgi Minkov ◽  
Emil Enchev ◽  
Krasimira Halacheva ◽  
Yovcho Yovtchev
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
University Hospital ◽  
High Morbidity ◽  
Operating Characteristics ◽  
Prognostic Performance ◽  
Prognostic Accuracy ◽  
Failure Assessment ◽  
Abdominal Infections ◽  
Qsofa Score

BACKGROUND: Despite the evolution in surgical treatment and antimicrobial therapy in the last years the complicated intra-abdominal infections (cIAIs) are still associated with high morbidity and mortality. Different scoring systems are already available for early prognostic evaluation and yet none has been widely accepted. AIM: Our aim was to evaluate the prognostic accuracy of quick sequential organ failure assessment (qSOFA), one of the most recent scores, in patients with cIAIs. MATERIALS AND METHODS: We studied retrospectively 110 patients with cIAIs admitted to the Department of Surgical Diseases (DSD) at University Hospital “Prof. Dr. Stoyan Kirkovich” Stara Zagora from January 2017 to July 2019. Area under receiver operating characteristics (AUROC) curves of systemic inflammatory response syndrome (SIRS), qSOFA, and Mannheim Peritonitis Index (MPI) were analyzed and a comparison of ROC curves was performed to explore their prognostic performance. RESULTS: Twenty-five (22.7%) patients died during hospitalization. qSOFA score showed poor prognostic accuracy (AUROC = 0.698, 95% CI = 0.566–0.829), worse than MPI score (AUROC = 0.698 vs. 0.844), but better than SIRS (AUROC = 0.698 vs. 0.583). The qSOFA score ≥2 points was observed with lack of sensitivity (32.0%) as outcome predictor. ROC curve analysis showed prognostic inferiority of qSOFA compared to MPI (difference between areas = 0.146, p = 0.0232). CONCLUSION: In patients with cIAIs, quick-SOFA score was observed with poor prognostic performance.

Sepsis nach elektiver Septumplastik und Nasenmuschelverkleinerung

2019 ◽  
Vol 98 (08) ◽  
pp. 571-574
Author(s):  
Katharina Stölzel ◽  
Lichun Zhang ◽  
Tordis Borowski ◽  
Heidi Olze ◽  
Tim Schroeder ◽  
...  
Keyword(s):  
Organ Failure ◽  
Assessment Score ◽  
Failure Assessment ◽  
Qsofa Score

FallberichtEin 20-jähriger adipöser Patient stellte sich im August 2018 in einer auswärtigen Klinik zur Septumplastik und Muschelverkleinerung bei Septumdeviation und Muschelhyperplasie ohne relevante Vorerkrankungen vor. Intraoperativ war keine Antibiotikagabe erfolgt. Postoperativ wurde der Patient zur weiteren Betreuung mit Doyle-Splinten und Gelaspon® auf die Normalstation verlegt. Es war Hochsommer und die Krankenzimmertemperatur bei ausgefallener Klimaanlage sehr hoch. Wie erst später fremdanamnestisch bekannt wurde, hatte der Patient eine bereits vor stationärer Aufnahme mehrere Tage bestehende, aber nicht mitgeteilte Enteritis. Am Morgen des ersten postoperativen Tages wies der Patient Zeichen der Sepsis auf: arterielle Hypotonie, Tachykardie, Tachypnoe und Desorientierung (= quick Sepsis – related organ failure assessment Score [qSOFA Score] = positiv). Es erfolgte die Gabe von Kristalloiden und bei Schwellung des Gesichtes die Entfernung der Doyle-Splinte. Ungeachtet dessen kam es zur progredienten Verschlechterung und Entwicklung eines schweren Schocks, so dass mit der Gabe von Vasopressoren begonnen wurde. Bei zusätzlich beginnender respiratorischer Erschöpfung wurde die Indikation zur Intubation gestellt. Während der Intubation kam es zur Aspiration. Zur weiteren intensivmedizinischen Versorgung erfolgte aus kapazitären Gründen die Verlegung auf die interdisziplinäre internistische Intensivstation unserer Klinik mit zunächst unklarem Infektfokus. Bei Übernahme war der Patient intubiert und beatmet (CPAP PEEP 9 mbar, Druckunterstützung 16 mbar, FiO2 0,8) und hoch katecholaminpflichtig (Noradrenalin 1 µg/kg/min, Epinephrin 0,2 µg/kg/min).

scholarly journals P082: Predictive ability of the quick Sepsis-related Organ Failure Assessment score among patients with infection transported by paramedics: a Bayesian analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S93
Author(s):  
S. Alex Love ◽  
D. Lane
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Bayesian Analysis ◽  
Organ Failure ◽  
Predictive Ability ◽  
Decision Threshold ◽  
Coma Scale ◽  
C Statistic ◽  
Failure Assessment ◽  
Qsofa Score

Introduction: The quick Sepsis-related Organ Failure Assessment (qSOFA) score was developed to provide clinicians with a quick assessment for patients with latent organ failure possibly consistent with sepsis at high-risk for mortality. With the clinical heterogeneity of patients presenting with sepsis, a Bayesian validation approach may provide a better understanding of its clinical utility. This study used a Bayesian analysis to assess the prediction of hospital mortality by the qSOFA score among patients with infection transported by paramedics. Methods: A one-year cohort of adult patients transported by paramedics in a large, provincial EMS system was linked to Emergency Department (ED) and hospital administrative databases, then restricted to those patients with an ED diagnosed infection. A Bayesian binomial regression model was constructed using Hamiltonian Markov-Chain Monte-Carlo sampling, normal priors for each parameter, the calculated score, age and sex as the predictors, and hospital mortality as the outcome. Discrimination was assessed using posterior predictions to calculate a “Bayesian” C statistic, and calibration was assessed with calibration plots of the observed and predicted probability distributions. The independent predictive ability of each measure was tested by including each component measure (respiratory rate, Glasgow Coma Scale, and systolic blood pressure) as continuous predictors in a second model. Results: A total of 9,920 patients with ED diagnosed infection were included. 264 (2.7%) patients were admitted directly to the ICU, and 955 (9.6%) patients died in-hospital. As independent predictors, the probability of mortality increased as each measure became more extreme, with the Glasgow Coma Scale predicting the greatest change in mortality risk from a high to low score; however, no dramatic change in the probability supporting a single decision threshold was seen for any measure. For the calculated score, the C statistic for predicting mortality was 0.728. The calibration curve had no overlap of predictions, with a probability of 0.5 (50% credible interval 0.47-0.53) for patients with a qSOFA score of 3. Conclusion: Although no single decision threshold was identified for each component measure, a calculated qSOFA score provides good prediction of mortality for patients with ED diagnosed infection. When validating clinical prediction scores, a Bayesian approach may be used to assess probabilities of interest for clinicians to support better clinical decision making. Character count 2494

scholarly journals A Cross-Sectional Survey of the Workplace Factors Contributing to Symptoms of Anxiety and Depression Among Nurses and Physicians During the First Wave of COVID-19 Pandemic in Two US Healthcare Systems

2021 ◽  
Author(s):  
Igor Burstyn ◽  
Karyn Holt
Keyword(s):  
Depression Scale ◽  
Participation Rate ◽  
Healthcare Systems ◽  
Working Environment ◽  
Mitigation Measures ◽  
Anxiety And Depression ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Psychological Burden ◽  
Nurses And Physicians

Abstract Background Anxiety and depression among physicians and nurses during the COVID-19 pandemic in the USA are not well described and their modifiable causes are poorly understood. Methods We conducted a cross-sectional survey of symptoms of anxiety and depression (Hospital Anxiety and Depression Scale) among physicians and nurses in two US healthcare systems in June through September 2020; participation rate was 5–10%. We described features of work as well as their perceptions and associated concerns in relation to the risk of anxiety and depression, while controlling for health history via regression and path analyses. Results About a third of 684 nurses and 185 physicians surveyed showed symptoms of anxiety or depression, and the excess of symptoms of mood disorders was particularly prominent in nurses. The belief that one was infected was a dominant correlate of both anxiety and depression. This belief was more associated with history of symptoms of pneumonia than the contact with COVID-19 diagnosed patients. Factors found to be associated with reduced anxiety and depression in this working environment were having confidence in the competent use of and access to personal protective equipment, maintaining usual working hours, being surrounded by colleagues who were both sufficient in numbers and not stressed, and the support of immediate family and religious communities. Involvement in aerosol-generating procedures with infected patients was linked with lower depression in nurses but higher among physicians. Likewise, the setting of recent patient encounters affected risk of anxiety and depression differently for physicians and nurses. Conclusions Our findings may help develop mitigation measures and underscore the need to help nurses and physicians bear the psychological burden of the COVID-19 pandemic and similar events in the future.

scholarly journals Patient safety culture in the maternal-child area of a university hospital

2020 ◽  
Vol 41 (spe) ◽  
Author(s):  
Vitoria Sandri Pedroni ◽  
Helga Geremia Gouveia ◽  
Letícia Becker Vieira ◽  
Wiliam Wegner ◽  
Adriana Catarina de Souza Oliveira ◽  
...  
Keyword(s):  
Patient Safety ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
Cross Sectional Study ◽  
Positive Answer ◽  
University Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nurses And Physicians ◽  
Maternal Child

ABSTRACT Objective: To describe the safety culture of the patient from the perspective of nurses and physicians working in the maternal-child area. Method: A cross-sectional study conducted from January to September 2018 with 41 professionals of the Obstetrics Center and obstetric hospitalization of a university hospital in the south of the country. The Hospital Survey on Patient Safety Culture was used, with 12 dimensions of the safety culture, measured by means of a general score (0 to 10) and of positive answer percentages to assess strengths and weaknesses. Results: The action of supervisors/bosses can be considered a strength of patient safety, with 78.2% of positive answers; already regarding communication, it was considered a fragility, punctuating 13.24%. The general safety grade of the patient assigned to the work’s unit was very good, in a confidence interval of 95%. Conclusion: With the identification of the strengths and weaknesses of patient safety, it is possible to plan improvement actions. We emphasize that the non-punitive approach is essential.

scholarly journals Comparison of QSOFA score and SIRS criteria for prediction of sepsis outcome of patients with suspicion of sepsis outside the intensive care unit: A single-center retrospective study

2021 ◽  
Author(s):  
Maryamsadat Mosavi ◽  
lida Mahfoozi
Keyword(s):  
Curve Analysis ◽  
Definite Diagnosis ◽  
Single Center ◽  
Suspected Sepsis ◽  
Failure Assessment ◽  
Invaluable Tool ◽  
Area Under Roc Curve ◽  
Qsofa Score ◽  
Sirs Criteria ◽  
Related Mortality

Abstract Objective:The present study aimed to determine quick Sepsis-related Organ Failure Assessment (qSOFA) in comparison with systemic inflammatory response syndrome (SIRS) in the prediction of the adverse consequences for the suspected sepsis patients outside the ICU.Results:Out of 128 patients with suspected sepsis, 87 (68%) patients were confirmed to have septicemia based on SIRS criteria. The SIRS criteria classified 68% patients as sepsis (87/128), of which 39(44.8%) had positive qSOFA score. The sensitivity and specificity ratios of qSOFA were 44.83% and 80.49%, respectively.ROC curve analysis showed that the area under ROC curve (AUC) of the pSOFA score for predicting the prognosis of sepsis patients were not significantly different. Moreover, regarding the sepsis-related mortality, the area under ROC showed that the qSOFA criteria (score ≥ 2) is suitable for predicting mortality with a sensitivity of 71% and specificity of 72%.Our findings revealed that the qSOFA score was significantly efficient in predicting mortality. However, the SIRS is more sensitive than the qSOFA score in predicting of the definite diagnosis of sepsis. Therefore, the qSOFA score may seem to be an invaluable tool for the identification of sepsis patients at the emergency department.

scholarly journals Public preferences for involvement in the governance of health data

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C De Freitas ◽  
M Amorim ◽  
E Leão Teles ◽  
T Maia ◽  
H Machado ◽  
...  
Keyword(s):  
Policy Development ◽  
Public Involvement ◽  
Participation Rate ◽  
Evidence Base ◽  
Health Data ◽  
Study Data ◽  
University Hospital ◽  
Willingness To Participate ◽  
Data Governance ◽  
Cross Sectional

Abstract Background Public involvement in the governance of epidemiological and public health studies can foster needs-driven research, enhance participants' recruitment, reduce attrition and improve the quality of and ethics in research and surveillance. However, it can also reinforce health inequalities if it fails to ensure public representation across socioeconomic gradients. This study aimed to assess patients' and carers' preferences for involvement in collective health data governance, and its associated factors, to strengthen the evidence base for policy development. Methods Between June 2019 and January 2020, 644 people (157 patients and 487 carers; participation rate=89.3%) followed at two reference centres for rare diseases in a university hospital from Northern Portugal were enrolled in an observational cross-sectional study. Data about willingness to participate in data governance was collected through four intersecting options: periodic or sporadic meetings, by either giving opinions (consultation) or participating in decision-making (deliberation). Data were analysed using descriptive and inferential statistics. Results From a total of 629 respondents, 39% are willing to get involved through at least one of the four participatory options and 16% do not want to participate. Patients and carers do not differ in their preferences for involvement. Sex and education are associated with willingness to participate, after adjustment for participant type (patient/carer), occupation and trust in national and international institutions (OR:1.60; 95%CI 1.05-2.45 for men vs. women and OR:1.65; 95%CI 1.07-2.56 for >12 vs. ≤12 educational years). Participants' preferred option for participation is consultative sporadic meetings (29.5%). Conclusions Anticipating which social groups are likely to become under-represented in participatory exercises is crucial to inform policy aimed at promoting inclusive involvement in health data governance. Key messages Men and higher educated participants are more willing to participate. Forecasting potential for subgroup under-representation is crucial to develop policy for inclusive participatory data governance.

scholarly journals qSOFA score for prediction of sepsis outcome in emergency department

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Kavous Shahsavarinia ◽  
Payman Moharramzadeh ◽  
Reza Jamal Arvanagi ◽  
Ata Mahmoodpoor
Keyword(s):  
Emergency Department ◽  
Risk Stratification ◽  
Organ Failure ◽  
Task Force ◽  
Warning Signs ◽  
P Value ◽  
International Consensus ◽  
Consensus Definition ◽  
Prediction Of Mortality ◽  
Qsofa Score

Objective: The third international consensus definition for sepsis and septic shock (sepsis 3) task force recently introduced qSOFA (quick sequential organ failure assessment) as a score for detection of patients at risk of sepsis outside of intensive care units. We performed this study to evaluate the validity of qSOFA for early detection and risk stratification of septic patients in emergency department. Methods: We conducted this study in an emergency department of the largest university affiliated hospital in northwest of Iran from Sept 2015 to Sept 2016. One hundred and forty patients who were SIRS positive with a suspected infection without alternative diagnosis and a microbiological proven infection were enrolled in this study. qSOFA was calculated for each patient and correlated with sepsis grades and mortality. Results: From 140 patients 84 (60%) had positive qSOFA score and 56 (40%) patients had negative qSOFA score. Our results showed that near half of patients with positive qSOFA expired during their stay in hospital while this was about 5% for patients with negative qSOFA. ROC curve of study regarding prediction of outcome with qSOFA showed an area under curve of 0.59. (P value: 0.04). Time spent to sepsis detection was 16 minutes shorter with qSOFA score compared to SIRS criteria in this study. Conclusion: In patients with suspected sepsis, qSOFA has acceptable value for risk stratification of severity, multi organ failure and mortality. It seems that education of medical staff and frequent screening of patients for warning signs can help to increase the value of qSOFA in prediction of mortality in critically ill septic patients. doi: https://doi.org/10.12669/pjms.36.4.2031 How to cite this:Shahsavarinia K, Moharramzadeh P, Arvanagi RJ, Mahmoodpoor A. qSOFA score for prediction of sepsis outcome in emergency department. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2031 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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