Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies
OBJECTIVE:Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension. METHODS:This secondary analysis evaluated a prospective cohort of consecutive patients w...
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| Veröffentlicht in: | Shock (Augusta, Ga.) Ga.), 2018-02, Vol.49 (2), p.131-136 |
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| creator | Henning, Daniel J Kearney, Kathleen E Hall, Michael Kennedy Mahr, Claudius Shapiro, Nathan I Nichol, Graham |
| description | OBJECTIVE:Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension.
METHODS:This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) |
| doi_str_mv | 10.1097/SHK.0000000000000945 |
| format | Article |
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METHODS:This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) < 90 mm Hg after at least 1 L of crystalloid or 2 units packed red blood cells, or SBP < 90 mm Hg and fluids withheld due to concern for fluid overload. The primary outcome was cardiogenic etiology, adjudicated by two physician chart review, with 25% paired chart review (kappa = 0.92). We used multivariable logistic regression to predict cardiogenic etiology, utilizing clinical data abstracted from the electronic medical record. We created a prediction score from significant covariates and calculated its test characteristics for cardiogenic hypotension.
RESULTS:Of 700 patients with hypotension, 107 (15.3%, 95% CI12.6%–18.0%) had cardiogenic etiology. Independent predictors of cardiogenic etiology were shortness of breath (OR 4.1, 95% CI2.5–6.7), troponin > 0.1 ng/mL (37.5, 7.1–198.2), electrocardiographic ischemia (8.9, 4.0–19.8), history of heart failure (2.0, 1.1–3.3), and absence of fever (4.5, 2.3–8.7) (area under the curve [AUC] = 0.83). The prediction score created from these predictors yielded 78% sensitivity and 77% specificity for cardiogenic etiology (AUC = 0.827).
CONCLUSIONS:Clinical predictors offer reasonable ED screening sensitivity for cardiogenic hypotension, while demonstrating sufficient specificity to facilitate early cardiac interventions.</description><identifier>ISSN: 1073-2322</identifier><identifier>EISSN: 1540-0514</identifier><identifier>DOI: 10.1097/SHK.0000000000000945</identifier><identifier>PMID: 28719490</identifier><language>eng</language><publisher>United States: by the Shock Society</publisher><subject>Aged ; Aged, 80 and over ; Area Under Curve ; Blood Pressure - physiology ; Cardiovascular Diseases - complications ; Emergency Service, Hospital - statistics & numerical data ; Female ; Humans ; Hypotension - etiology ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Retrospective Studies</subject><ispartof>Shock (Augusta, Ga.), 2018-02, Vol.49 (2), p.131-136</ispartof><rights>2018 by the Shock Society</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3565-bb5ef040a453b49ea68bb5bbd12f2821af75ceb0543959a2223ceab5feb0ea8f3</citedby><cites>FETCH-LOGICAL-c3565-bb5ef040a453b49ea68bb5bbd12f2821af75ceb0543959a2223ceab5feb0ea8f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28719490$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Henning, Daniel J</creatorcontrib><creatorcontrib>Kearney, Kathleen E</creatorcontrib><creatorcontrib>Hall, Michael Kennedy</creatorcontrib><creatorcontrib>Mahr, Claudius</creatorcontrib><creatorcontrib>Shapiro, Nathan I</creatorcontrib><creatorcontrib>Nichol, Graham</creatorcontrib><title>Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies</title><title>Shock (Augusta, Ga.)</title><addtitle>Shock</addtitle><description>OBJECTIVE:Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension.
METHODS:This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) < 90 mm Hg after at least 1 L of crystalloid or 2 units packed red blood cells, or SBP < 90 mm Hg and fluids withheld due to concern for fluid overload. The primary outcome was cardiogenic etiology, adjudicated by two physician chart review, with 25% paired chart review (kappa = 0.92). We used multivariable logistic regression to predict cardiogenic etiology, utilizing clinical data abstracted from the electronic medical record. We created a prediction score from significant covariates and calculated its test characteristics for cardiogenic hypotension.
RESULTS:Of 700 patients with hypotension, 107 (15.3%, 95% CI12.6%–18.0%) had cardiogenic etiology. Independent predictors of cardiogenic etiology were shortness of breath (OR 4.1, 95% CI2.5–6.7), troponin > 0.1 ng/mL (37.5, 7.1–198.2), electrocardiographic ischemia (8.9, 4.0–19.8), history of heart failure (2.0, 1.1–3.3), and absence of fever (4.5, 2.3–8.7) (area under the curve [AUC] = 0.83). The prediction score created from these predictors yielded 78% sensitivity and 77% specificity for cardiogenic etiology (AUC = 0.827).
CONCLUSIONS:Clinical predictors offer reasonable ED screening sensitivity for cardiogenic hypotension, while demonstrating sufficient specificity to facilitate early cardiac interventions.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Area Under Curve</subject><subject>Blood Pressure - physiology</subject><subject>Cardiovascular Diseases - complications</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - etiology</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><issn>1073-2322</issn><issn>1540-0514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kNFLwzAQxoMoTqf_gUgffelM0mRtHmVONxwoqPhY0vSyRdumJq1j_72RTREfvJfvOH733fEhdEbwiGCRXj7O7kb4dwnG99AR4QzHmBO2H3qcJjFNKB2gY-9fMaYsEekhGtAsJYIJfIRe5iU0ndFGyc7YJrI6mm1a20HjzQdE0xrcEhq1ia6hla6rAxw9BDSoj9amW0UT6UpjA2RUNA0elV0a8CfoQMvKw-lOh-j5Zvo0mcWL-9v55GoRq4SPeVwUHDRmWDKeFEyAHGdhVBQloZpmlEidcgUF5uFxLiSlNFEgC67DDGSmkyG62Pq2zr734Lu8Nl5BVckGbO9zIihOBCEpDijbospZ7x3ovHWmlm6TE5x_RZqHSPO_kYa1892Fvqih_Fn6zjAA2RZY26oD59-qfg0uX4GsutX_3p_QvoQ-</recordid><startdate>201802</startdate><enddate>201802</enddate><creator>Henning, Daniel J</creator><creator>Kearney, Kathleen E</creator><creator>Hall, Michael Kennedy</creator><creator>Mahr, Claudius</creator><creator>Shapiro, Nathan I</creator><creator>Nichol, Graham</creator><general>by the Shock Society</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>7X8</scope></search><sort><creationdate>201802</creationdate><title>Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies</title><author>Henning, Daniel J ; Kearney, Kathleen E ; Hall, Michael Kennedy ; Mahr, Claudius ; Shapiro, Nathan I ; Nichol, Graham</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3565-bb5ef040a453b49ea68bb5bbd12f2821af75ceb0543959a2223ceab5feb0ea8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Area Under Curve</topic><topic>Blood Pressure - physiology</topic><topic>Cardiovascular Diseases - complications</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - etiology</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Henning, Daniel J</creatorcontrib><creatorcontrib>Kearney, Kathleen E</creatorcontrib><creatorcontrib>Hall, Michael Kennedy</creatorcontrib><creatorcontrib>Mahr, Claudius</creatorcontrib><creatorcontrib>Shapiro, Nathan I</creatorcontrib><creatorcontrib>Nichol, Graham</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Shock (Augusta, Ga.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Henning, Daniel J</au><au>Kearney, Kathleen E</au><au>Hall, Michael Kennedy</au><au>Mahr, Claudius</au><au>Shapiro, Nathan I</au><au>Nichol, Graham</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies</atitle><jtitle>Shock (Augusta, Ga.)</jtitle><addtitle>Shock</addtitle><date>2018-02</date><risdate>2018</risdate><volume>49</volume><issue>2</issue><spage>131</spage><epage>136</epage><pages>131-136</pages><issn>1073-2322</issn><eissn>1540-0514</eissn><abstract>OBJECTIVE:Identify predictors of cardiogenic etiology among emergency department (ED) patients with hypotension, and use these predictors to create a clinical tool to discern cardiogenic etiology of hypotension.
METHODS:This secondary analysis evaluated a prospective cohort of consecutive patients with hypotension in an urban, academic, tertiary care ED from November 2012 to September 2013. We included adults with hypotension, defined as a new vasopressor requirement, systolic blood pressure (SBP) < 90 mm Hg after at least 1 L of crystalloid or 2 units packed red blood cells, or SBP < 90 mm Hg and fluids withheld due to concern for fluid overload. The primary outcome was cardiogenic etiology, adjudicated by two physician chart review, with 25% paired chart review (kappa = 0.92). We used multivariable logistic regression to predict cardiogenic etiology, utilizing clinical data abstracted from the electronic medical record. We created a prediction score from significant covariates and calculated its test characteristics for cardiogenic hypotension.
RESULTS:Of 700 patients with hypotension, 107 (15.3%, 95% CI12.6%–18.0%) had cardiogenic etiology. Independent predictors of cardiogenic etiology were shortness of breath (OR 4.1, 95% CI2.5–6.7), troponin > 0.1 ng/mL (37.5, 7.1–198.2), electrocardiographic ischemia (8.9, 4.0–19.8), history of heart failure (2.0, 1.1–3.3), and absence of fever (4.5, 2.3–8.7) (area under the curve [AUC] = 0.83). The prediction score created from these predictors yielded 78% sensitivity and 77% specificity for cardiogenic etiology (AUC = 0.827).
CONCLUSIONS:Clinical predictors offer reasonable ED screening sensitivity for cardiogenic hypotension, while demonstrating sufficient specificity to facilitate early cardiac interventions.</abstract><cop>United States</cop><pub>by the Shock Society</pub><pmid>28719490</pmid><doi>10.1097/SHK.0000000000000945</doi><tpages>6</tpages></addata></record> |
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| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Area Under Curve Blood Pressure - physiology Cardiovascular Diseases - complications Emergency Service, Hospital - statistics & numerical data Female Humans Hypotension - etiology Logistic Models Male Middle Aged Prospective Studies Retrospective Studies |
| title | Identification of Hypotensive Emergency Department Patients with Cardiogenic Etiologies |
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