Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis
Background Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes. Objective...
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| Veröffentlicht in: | Academic emergency medicine 2014-08, Vol.21 (8), p.853-857 |
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| creator | Singer, Adam J. Taylor, Merry Domingo, Anna Ghazipura, Saad Khorasonchi, Adam Thode, Henry C. Shapiro, Nathan I. Jang, Timothy |
| description | Background
Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes.
Objectives
The objective was to determine the diagnostic characteristics of a clinical screening tool in combination with measuring early bedside point‐of‐care (POC) lactate levels in emergency department (ED) patients with suspected sepsis.
Methods
This was a prospective, observational study set at a suburban academic ED with an annual census of 90,000. A convenience sample of adult ED patients with suspected infection were screened with a sepsis screening tool for the presence of at least one of the following: temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or altered mental status. Patients meeting criteria had bedside POC lactate testing following triage, which was immediately reported to the treating physician if ≥2.0 mmol/L. Demographic and clinical information, including lactate levels, ED interventions, and final diagnosis, were recorded. Outcomes included presence or absence of sepsis using the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions and intensive care unit (ICU) admissions, use of vasopressors, and mortality. Diagnostic test characteristics were calculated using 2‐by‐2 tables with their 95% confidence intervals (CIs). The association between bedside lactate and ICU admissions, use of vasopressors, and mortality was determined using logistic regression.
Results
A total of 258 patients were screened for sepsis. Their mean (± standard deviation [SD]) age was 64 (±19) years; 46% were female, and 82% were white. Lactate levels were 2.0 mmol/L or greater in 80 (31%) patients. Patients were confirmed to meet sepsis criteria in 208 patients (81%). The diagnostic characteristics for sepsis of the combined clinical screening tool and bedside lactates were sensitivity 34% (95% CI = 28% to 41%), specificity 82% (95% CI = 69% to 90%), positive predictive value 89% (95% CI = 80% to 94%), and negative predictive value 23% (95% CI = 17% to 30%). Bedside lactate levels were associated with sepsis severity (p |
| doi_str_mv | 10.1111/acem.12444 |
| format | Article |
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Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes.
Objectives
The objective was to determine the diagnostic characteristics of a clinical screening tool in combination with measuring early bedside point‐of‐care (POC) lactate levels in emergency department (ED) patients with suspected sepsis.
Methods
This was a prospective, observational study set at a suburban academic ED with an annual census of 90,000. A convenience sample of adult ED patients with suspected infection were screened with a sepsis screening tool for the presence of at least one of the following: temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or altered mental status. Patients meeting criteria had bedside POC lactate testing following triage, which was immediately reported to the treating physician if ≥2.0 mmol/L. Demographic and clinical information, including lactate levels, ED interventions, and final diagnosis, were recorded. Outcomes included presence or absence of sepsis using the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions and intensive care unit (ICU) admissions, use of vasopressors, and mortality. Diagnostic test characteristics were calculated using 2‐by‐2 tables with their 95% confidence intervals (CIs). The association between bedside lactate and ICU admissions, use of vasopressors, and mortality was determined using logistic regression.
Results
A total of 258 patients were screened for sepsis. Their mean (± standard deviation [SD]) age was 64 (±19) years; 46% were female, and 82% were white. Lactate levels were 2.0 mmol/L or greater in 80 (31%) patients. Patients were confirmed to meet sepsis criteria in 208 patients (81%). The diagnostic characteristics for sepsis of the combined clinical screening tool and bedside lactates were sensitivity 34% (95% CI = 28% to 41%), specificity 82% (95% CI = 69% to 90%), positive predictive value 89% (95% CI = 80% to 94%), and negative predictive value 23% (95% CI = 17% to 30%). Bedside lactate levels were associated with sepsis severity (p < 0.001), ICU admission (odds ratio [OR] = 2.01; 95% CI = 1.53 to 2.63), and need for vasopressors (OR = 1.54; 95% CI = 1.13 to 2.12).
Conclusions
Use of a clinical screening tool in combination with early bedside POC lactates has moderate to good specificity but low sensitivity in adult ED patients with suspected sepsis. Elevated bedside lactate levels are associated with poor outcomes.
Resumen
Antecedentes
La identificación precoz de la sepsis y el inicio de un tratamiento enérgico salva vidas. Sin embargo, el diagnóstico de sepsis puede retrasarse en pacientes sin gran deterioro. Las herramientas de despistaje clínico y los valores séricos de lactato quizá puedan ayudar a identificar a los pacientes sépticos con riesgo de resultados adversos.
Objetivos
El objetivo fue determinar las características diagnósticas de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama en los pacientes con sospecha de sepsis del servicio de urgencias (SU).
Metodología
Estudio observacional y prospectivo llevado a cabo en un SU universitario suburbano con un censo anual de 90.000 atenciones. Una muestra de conveniencia de pacientes adultos del SU con sospecha de infección fue cribada con una herramienta de despistaje para la sepsis para la presencia de al menos uno de los siguientes hallazgos: temperatura mayor a 38°C o menor a 36°C, frecuencia cardíaca mayor a 90 latidos/min, frecuencia respiratoria mayor a 20 respiraciones/min o estado mental alterado. En los pacientes que cumplían los criterios, se obtuvo un lactato a pie de cama tras el triaje, que fue comunicado de forma inmediata al médico responsable del tratamiento si éste era 2,0 mmol/L. Se recogieron datos demográficos y clínicos, que incluyeron los valores de lactato, los procedimientos en el SU y el diagnóstico final. Los resultados recogieron la presencia o ausencia de sepsis según las definiciones de la conferencia consenso del American College of Chest Physicians/Society of Critical Care Medicine; el ingreso en unidades de cuidados intensivos (UCI), el uso de vasopresores y la mortalidad. Se calcularon las características diagnósticas del test usando tablas 2 por 2 con sus respectivos intervalos de confianza (IC) al 95%. Se determinó mediante una regresión logística la asociación del lactato a pie de cama con el ingreso en UCI, el uso de vasopresores y la mortalidad.
Resultados
Se cribaron 258 pacientes para sepsis. La media de edad (desviación estándar [DE]) fue 64 (19); un 46% eran mujeres, y un 82% caucásicos. Los valores de lactato fueron de 2,0 mmol/L o más en 80 pacientes (31%). Se confirmó que 208 pacientes (81%) cumplían los criterios de sepsis. Las características diagnósticas para sepsis de la combinación de la herramienta de despistaje clínico junto con los valores de lactato a pie de cama fueron: sensibilidad 34% (IC 95% = 28% a 41%); especificidad 82% (IC 95% = 69% a 90%); valor predictivo positivo 89% (IC 95% = 80% a 94%); valor predictivo negativo 23% (IC 95% = 17% a 30%). El lactato a pie de cama se asoció con la gravedad de la sepsis (p < 0,001), el ingreso en UCI (OR = 2,01; IC 95% = 1,53 a 2,63), la necesidad de vasopresores (OR 1,54; IC 95% = 1,13 a 2,12) y la mortalidad (OR 1,57; IC 95% = 0,99 a 2,19).
Conclusiones
El uso de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama tiene una buena especificidad pero una baja sensibilidad en los pacientes adultos con sospecha de sepsis del SU. Los valores elevados de lactato a pie de cama se asociaron con peores resultados.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/acem.12444</identifier><identifier>PMID: 25155163</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biomarkers - blood ; Clinical outcomes ; Decision Support Techniques ; Emergency medical care ; Emergency Service, Hospital ; Female ; Health Status Indicators ; Humans ; Intensive care ; Lactic Acid - blood ; Logistic Models ; Male ; Medical diagnosis ; Medical screening ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Point-of-Care Systems ; Prognosis ; Prospective Studies ; Sensitivity and Specificity ; Sepsis ; Sepsis - blood ; Sepsis - diagnosis ; Sepsis - mortality ; Triage - methods</subject><ispartof>Academic emergency medicine, 2014-08, Vol.21 (8), p.853-857</ispartof><rights>2014 by the Society for Academic Emergency Medicine</rights><rights>2014 by the Society for Academic Emergency Medicine.</rights><rights>Copyright Hanley & Belfus, Inc. Aug 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3934-4a061c4fb0436efb51d50865348b6d7e9c38f25e9d51219d8b7cc87728a7c7793</citedby><cites>FETCH-LOGICAL-c3934-4a061c4fb0436efb51d50865348b6d7e9c38f25e9d51219d8b7cc87728a7c7793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1411,1427,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25155163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Jang, Timothy</contributor><creatorcontrib>Singer, Adam J.</creatorcontrib><creatorcontrib>Taylor, Merry</creatorcontrib><creatorcontrib>Domingo, Anna</creatorcontrib><creatorcontrib>Ghazipura, Saad</creatorcontrib><creatorcontrib>Khorasonchi, Adam</creatorcontrib><creatorcontrib>Thode, Henry C.</creatorcontrib><creatorcontrib>Shapiro, Nathan I.</creatorcontrib><creatorcontrib>Jang, Timothy</creatorcontrib><title>Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Background
Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes.
Objectives
The objective was to determine the diagnostic characteristics of a clinical screening tool in combination with measuring early bedside point‐of‐care (POC) lactate levels in emergency department (ED) patients with suspected sepsis.
Methods
This was a prospective, observational study set at a suburban academic ED with an annual census of 90,000. A convenience sample of adult ED patients with suspected infection were screened with a sepsis screening tool for the presence of at least one of the following: temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or altered mental status. Patients meeting criteria had bedside POC lactate testing following triage, which was immediately reported to the treating physician if ≥2.0 mmol/L. Demographic and clinical information, including lactate levels, ED interventions, and final diagnosis, were recorded. Outcomes included presence or absence of sepsis using the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions and intensive care unit (ICU) admissions, use of vasopressors, and mortality. Diagnostic test characteristics were calculated using 2‐by‐2 tables with their 95% confidence intervals (CIs). The association between bedside lactate and ICU admissions, use of vasopressors, and mortality was determined using logistic regression.
Results
A total of 258 patients were screened for sepsis. Their mean (± standard deviation [SD]) age was 64 (±19) years; 46% were female, and 82% were white. Lactate levels were 2.0 mmol/L or greater in 80 (31%) patients. Patients were confirmed to meet sepsis criteria in 208 patients (81%). The diagnostic characteristics for sepsis of the combined clinical screening tool and bedside lactates were sensitivity 34% (95% CI = 28% to 41%), specificity 82% (95% CI = 69% to 90%), positive predictive value 89% (95% CI = 80% to 94%), and negative predictive value 23% (95% CI = 17% to 30%). Bedside lactate levels were associated with sepsis severity (p < 0.001), ICU admission (odds ratio [OR] = 2.01; 95% CI = 1.53 to 2.63), and need for vasopressors (OR = 1.54; 95% CI = 1.13 to 2.12).
Conclusions
Use of a clinical screening tool in combination with early bedside POC lactates has moderate to good specificity but low sensitivity in adult ED patients with suspected sepsis. Elevated bedside lactate levels are associated with poor outcomes.
Resumen
Antecedentes
La identificación precoz de la sepsis y el inicio de un tratamiento enérgico salva vidas. Sin embargo, el diagnóstico de sepsis puede retrasarse en pacientes sin gran deterioro. Las herramientas de despistaje clínico y los valores séricos de lactato quizá puedan ayudar a identificar a los pacientes sépticos con riesgo de resultados adversos.
Objetivos
El objetivo fue determinar las características diagnósticas de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama en los pacientes con sospecha de sepsis del servicio de urgencias (SU).
Metodología
Estudio observacional y prospectivo llevado a cabo en un SU universitario suburbano con un censo anual de 90.000 atenciones. Una muestra de conveniencia de pacientes adultos del SU con sospecha de infección fue cribada con una herramienta de despistaje para la sepsis para la presencia de al menos uno de los siguientes hallazgos: temperatura mayor a 38°C o menor a 36°C, frecuencia cardíaca mayor a 90 latidos/min, frecuencia respiratoria mayor a 20 respiraciones/min o estado mental alterado. En los pacientes que cumplían los criterios, se obtuvo un lactato a pie de cama tras el triaje, que fue comunicado de forma inmediata al médico responsable del tratamiento si éste era 2,0 mmol/L. Se recogieron datos demográficos y clínicos, que incluyeron los valores de lactato, los procedimientos en el SU y el diagnóstico final. Los resultados recogieron la presencia o ausencia de sepsis según las definiciones de la conferencia consenso del American College of Chest Physicians/Society of Critical Care Medicine; el ingreso en unidades de cuidados intensivos (UCI), el uso de vasopresores y la mortalidad. Se calcularon las características diagnósticas del test usando tablas 2 por 2 con sus respectivos intervalos de confianza (IC) al 95%. Se determinó mediante una regresión logística la asociación del lactato a pie de cama con el ingreso en UCI, el uso de vasopresores y la mortalidad.
Resultados
Se cribaron 258 pacientes para sepsis. La media de edad (desviación estándar [DE]) fue 64 (19); un 46% eran mujeres, y un 82% caucásicos. Los valores de lactato fueron de 2,0 mmol/L o más en 80 pacientes (31%). Se confirmó que 208 pacientes (81%) cumplían los criterios de sepsis. Las características diagnósticas para sepsis de la combinación de la herramienta de despistaje clínico junto con los valores de lactato a pie de cama fueron: sensibilidad 34% (IC 95% = 28% a 41%); especificidad 82% (IC 95% = 69% a 90%); valor predictivo positivo 89% (IC 95% = 80% a 94%); valor predictivo negativo 23% (IC 95% = 17% a 30%). El lactato a pie de cama se asoció con la gravedad de la sepsis (p < 0,001), el ingreso en UCI (OR = 2,01; IC 95% = 1,53 a 2,63), la necesidad de vasopresores (OR 1,54; IC 95% = 1,13 a 2,12) y la mortalidad (OR 1,57; IC 95% = 0,99 a 2,19).
Conclusiones
El uso de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama tiene una buena especificidad pero una baja sensibilidad en los pacientes adultos con sospecha de sepsis del SU. Los valores elevados de lactato a pie de cama se asociaron con peores resultados.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Clinical outcomes</subject><subject>Decision Support Techniques</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Health Status Indicators</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Lactic Acid - blood</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical screening</subject><subject>Middle Aged</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Point-of-Care Systems</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis</subject><subject>Sepsis - blood</subject><subject>Sepsis - diagnosis</subject><subject>Sepsis - mortality</subject><subject>Triage - methods</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhiMEoqWw4QGQJTYIKcV3J8uSDhdpKpCmiKXlOCdTV4md2gloXocnxdMUFizw5veRvvPpSH9RvCT4nOT3zlgYzwnlnD8qTokQrKSK0Mf5j2VdSiHZSfEspVuMsVC1elqcUJExItlp8evSmb0PaXYWNTcmGjtDdMcxodAjg5rBeWfNgHY2Anjn9-g6hAE5j5owts6b2QWPvrv5Bl2BSUs8Iu-hS64DtM0-M-eEH3C_sxkh7sHbA7qEycR5BD-jr9mRM62W3ZImyGd0aAdTcul58aQ3Q4IXD3lWfPuwuW4-ldsvHz83F9vSsprxkhssieV9izmT0LeCdAJXUjBetbJTUFtW9VRA3QlCSd1VrbK2UopWRlmlanZWvFm9Uwx3C6RZjy5ZGAbjISxJE0korSohSUZf_4PehiX6fJ0mQmIpKs5Ypt6ulI0hpQi9nqIbTTxogvWxOX1sTt83l-FXD8qlHaH7i_6pKgNkBX66AQ7_UemLZnO1Sn8D19ikXw</recordid><startdate>201408</startdate><enddate>201408</enddate><creator>Singer, Adam J.</creator><creator>Taylor, Merry</creator><creator>Domingo, Anna</creator><creator>Ghazipura, Saad</creator><creator>Khorasonchi, Adam</creator><creator>Thode, Henry C.</creator><creator>Shapiro, Nathan I.</creator><creator>Jang, Timothy</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201408</creationdate><title>Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis</title><author>Singer, Adam J. ; Taylor, Merry ; Domingo, Anna ; Ghazipura, Saad ; Khorasonchi, Adam ; Thode, Henry C. ; Shapiro, Nathan I. ; Jang, Timothy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3934-4a061c4fb0436efb51d50865348b6d7e9c38f25e9d51219d8b7cc87728a7c7793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Clinical outcomes</topic><topic>Decision Support Techniques</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Health Status Indicators</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Lactic Acid - blood</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical screening</topic><topic>Middle Aged</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Point-of-Care Systems</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Sepsis</topic><topic>Sepsis - blood</topic><topic>Sepsis - diagnosis</topic><topic>Sepsis - mortality</topic><topic>Triage - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Singer, Adam J.</creatorcontrib><creatorcontrib>Taylor, Merry</creatorcontrib><creatorcontrib>Domingo, Anna</creatorcontrib><creatorcontrib>Ghazipura, Saad</creatorcontrib><creatorcontrib>Khorasonchi, Adam</creatorcontrib><creatorcontrib>Thode, Henry C.</creatorcontrib><creatorcontrib>Shapiro, Nathan I.</creatorcontrib><creatorcontrib>Jang, Timothy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singer, Adam J.</au><au>Taylor, Merry</au><au>Domingo, Anna</au><au>Ghazipura, Saad</au><au>Khorasonchi, Adam</au><au>Thode, Henry C.</au><au>Shapiro, Nathan I.</au><au>Jang, Timothy</au><au>Jang, Timothy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2014-08</date><risdate>2014</risdate><volume>21</volume><issue>8</issue><spage>853</spage><epage>857</epage><pages>853-857</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Background
Early identification of sepsis and initiation of aggressive treatment saves lives. However, the diagnosis of sepsis may be delayed in patients without overt deterioration. Clinical screening tools and lactate levels may help identify sepsis patients at risk for adverse outcomes.
Objectives
The objective was to determine the diagnostic characteristics of a clinical screening tool in combination with measuring early bedside point‐of‐care (POC) lactate levels in emergency department (ED) patients with suspected sepsis.
Methods
This was a prospective, observational study set at a suburban academic ED with an annual census of 90,000. A convenience sample of adult ED patients with suspected infection were screened with a sepsis screening tool for the presence of at least one of the following: temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats/min, respiratory rate greater than 20 breaths/min, or altered mental status. Patients meeting criteria had bedside POC lactate testing following triage, which was immediately reported to the treating physician if ≥2.0 mmol/L. Demographic and clinical information, including lactate levels, ED interventions, and final diagnosis, were recorded. Outcomes included presence or absence of sepsis using the American College of Chest Physicians/Society of Critical Care Medicine consensus conference definitions and intensive care unit (ICU) admissions, use of vasopressors, and mortality. Diagnostic test characteristics were calculated using 2‐by‐2 tables with their 95% confidence intervals (CIs). The association between bedside lactate and ICU admissions, use of vasopressors, and mortality was determined using logistic regression.
Results
A total of 258 patients were screened for sepsis. Their mean (± standard deviation [SD]) age was 64 (±19) years; 46% were female, and 82% were white. Lactate levels were 2.0 mmol/L or greater in 80 (31%) patients. Patients were confirmed to meet sepsis criteria in 208 patients (81%). The diagnostic characteristics for sepsis of the combined clinical screening tool and bedside lactates were sensitivity 34% (95% CI = 28% to 41%), specificity 82% (95% CI = 69% to 90%), positive predictive value 89% (95% CI = 80% to 94%), and negative predictive value 23% (95% CI = 17% to 30%). Bedside lactate levels were associated with sepsis severity (p < 0.001), ICU admission (odds ratio [OR] = 2.01; 95% CI = 1.53 to 2.63), and need for vasopressors (OR = 1.54; 95% CI = 1.13 to 2.12).
Conclusions
Use of a clinical screening tool in combination with early bedside POC lactates has moderate to good specificity but low sensitivity in adult ED patients with suspected sepsis. Elevated bedside lactate levels are associated with poor outcomes.
Resumen
Antecedentes
La identificación precoz de la sepsis y el inicio de un tratamiento enérgico salva vidas. Sin embargo, el diagnóstico de sepsis puede retrasarse en pacientes sin gran deterioro. Las herramientas de despistaje clínico y los valores séricos de lactato quizá puedan ayudar a identificar a los pacientes sépticos con riesgo de resultados adversos.
Objetivos
El objetivo fue determinar las características diagnósticas de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama en los pacientes con sospecha de sepsis del servicio de urgencias (SU).
Metodología
Estudio observacional y prospectivo llevado a cabo en un SU universitario suburbano con un censo anual de 90.000 atenciones. Una muestra de conveniencia de pacientes adultos del SU con sospecha de infección fue cribada con una herramienta de despistaje para la sepsis para la presencia de al menos uno de los siguientes hallazgos: temperatura mayor a 38°C o menor a 36°C, frecuencia cardíaca mayor a 90 latidos/min, frecuencia respiratoria mayor a 20 respiraciones/min o estado mental alterado. En los pacientes que cumplían los criterios, se obtuvo un lactato a pie de cama tras el triaje, que fue comunicado de forma inmediata al médico responsable del tratamiento si éste era 2,0 mmol/L. Se recogieron datos demográficos y clínicos, que incluyeron los valores de lactato, los procedimientos en el SU y el diagnóstico final. Los resultados recogieron la presencia o ausencia de sepsis según las definiciones de la conferencia consenso del American College of Chest Physicians/Society of Critical Care Medicine; el ingreso en unidades de cuidados intensivos (UCI), el uso de vasopresores y la mortalidad. Se calcularon las características diagnósticas del test usando tablas 2 por 2 con sus respectivos intervalos de confianza (IC) al 95%. Se determinó mediante una regresión logística la asociación del lactato a pie de cama con el ingreso en UCI, el uso de vasopresores y la mortalidad.
Resultados
Se cribaron 258 pacientes para sepsis. La media de edad (desviación estándar [DE]) fue 64 (19); un 46% eran mujeres, y un 82% caucásicos. Los valores de lactato fueron de 2,0 mmol/L o más en 80 pacientes (31%). Se confirmó que 208 pacientes (81%) cumplían los criterios de sepsis. Las características diagnósticas para sepsis de la combinación de la herramienta de despistaje clínico junto con los valores de lactato a pie de cama fueron: sensibilidad 34% (IC 95% = 28% a 41%); especificidad 82% (IC 95% = 69% a 90%); valor predictivo positivo 89% (IC 95% = 80% a 94%); valor predictivo negativo 23% (IC 95% = 17% a 30%). El lactato a pie de cama se asoció con la gravedad de la sepsis (p < 0,001), el ingreso en UCI (OR = 2,01; IC 95% = 1,53 a 2,63), la necesidad de vasopresores (OR 1,54; IC 95% = 1,13 a 2,12) y la mortalidad (OR 1,57; IC 95% = 0,99 a 2,19).
Conclusiones
El uso de una herramienta de despistaje clínico en combinación con la medición precoz del lactato a pie de cama tiene una buena especificidad pero una baja sensibilidad en los pacientes adultos con sospecha de sepsis del SU. Los valores elevados de lactato a pie de cama se asociaron con peores resultados.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25155163</pmid><doi>10.1111/acem.12444</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1069-6563 |
| ispartof | Academic emergency medicine, 2014-08, Vol.21 (8), p.853-857 |
| issn | 1069-6563 1553-2712 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1612288561 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content |
| subjects | Adult Aged Aged, 80 and over Biomarkers - blood Clinical outcomes Decision Support Techniques Emergency medical care Emergency Service, Hospital Female Health Status Indicators Humans Intensive care Lactic Acid - blood Logistic Models Male Medical diagnosis Medical screening Middle Aged Outcome and Process Assessment (Health Care) Point-of-Care Systems Prognosis Prospective Studies Sensitivity and Specificity Sepsis Sepsis - blood Sepsis - diagnosis Sepsis - mortality Triage - methods |
| title | Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-21T11%3A16%3A18IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Diagnostic%20Characteristics%20of%20a%20Clinical%20Screening%20Tool%20in%20Combination%20With%20Measuring%20Bedside%20Lactate%20Level%20in%20Emergency%20Department%20Patients%20With%20Suspected%20Sepsis&rft.jtitle=Academic%20emergency%20medicine&rft.au=Singer,%20Adam%20J.&rft.date=2014-08&rft.volume=21&rft.issue=8&rft.spage=853&rft.epage=857&rft.pages=853-857&rft.issn=1069-6563&rft.eissn=1553-2712&rft_id=info:doi/10.1111/acem.12444&rft_dat=%3Cproquest_cross%3E1612288561%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1560658433&rft_id=info:pmid/25155163&rfr_iscdi=true |