Comparison of Sepsis Screening Tools' Ability to Detect Sepsis Accurately

Wawrose, Richard A.; Baraniuk, Mary Sarah; Standiford, Lauren; Wade, Charles E.; Holcomb, John B.; Moore, Laura J.

doi:10.1089/sur.2015.069

Cited by 13 publications

(9 citation statements)

References 7 publications

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“…The target population includes critically ill, traumatically injured or surgical patients who have septic shock. Patients who meet the inclusion criteria of ≥18 years old and have a Sepsis Screening Score ≥4 16 with a suspected source of infection ( figure 2 ) will be eligible for enrollment. Enrolled patients with hypotension with mean arterial pressure <65 mm Hg, and signs of hypoperfusion such as lactic acid >2.2 mmol/L, altered mental status or decreased urine output (<0.5 mL/kg in the past hour) will be randomized to receive either crystalloid or plasma resuscitation.…”

Section: Methodsmentioning

confidence: 99%

Protocol for a pilot randomized controlled trial comparing plasma with balanced crystalloid resuscitation in surgical and trauma patients with septic shock

Wei

Kao

Wang

et al. 2018

Trauma Surg Acute Care Open

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BackgroundSeptic shock is a public health problem with high mortality. There remains a knowledge gap regarding the optimal resuscitation fluid to improve clinical outcomes, and the underlying mechanism by which fluids exert their effect. Shock-induced endotheliopathy (SHINE) is thought to be a shared pathophysiologic mechanism associated with worsened outcomes in critically ill trauma and sepsis patients. SHINE is characterized by breakdown of the glycocalyx—a network of membrane-bound proteoglycans and glycoproteins that covers the endothelium. This has been associated with capillary leakage and microvascular thrombosis, organ dysfunction, and mortality. Biomarkers of SHINE have been shown to correlate with clinical outcomes in patients with septic shock. Interventions to mitigate SHINE may improve outcomes in patients with septic shock. In surgical/trauma patients with septic shock, initial plasma resuscitation as compared with balanced crystalloid (BC) resuscitation will mitigate biomarkers of SHINE and improve clinical outcomes.MethodsA pilot, single-center randomized controlled trial (RCT) will compare initial plasma to BC resuscitation in surgical and trauma patients with septic shock. Patients will be enrolled based on a Sepsis Screening Score of ≥4 with a suspected source of infection. Patient randomization only occurs if they meet the criteria: (1) hypotension with mean arterial pressure <65 mm Hg, and (2) evidence of hypoperfusion including lactic acid >4 mmol/L, altered mental status or decreased urine output of <0.5 mL/kg in the past hour.ResultsThe primary outcome is a reduction in serum biomarkers at 6 hours. Secondary outcomes will include clinical outcomes such as intensive care unit-free days, organ dysfunction, and in-hospital mortality.DiscussionThis trial will provide insights into the effects of initial plasma resuscitation on SHINE. Furthermore, it will provide unbiased estimates regarding the feasibility, safety, and clinical efficacy of plasma resuscitation in septic shock on which to base subsequent adequately powered multicenter RCTs.Trail registration numberClinicalTrials.gov (NCT03366220).

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Section: Methodsmentioning

confidence: 99%

Protocol for a pilot randomized controlled trial comparing plasma with balanced crystalloid resuscitation in surgical and trauma patients with septic shock

Wei

Kao

Wang

et al. 2018

Trauma Surg Acute Care Open

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“…A range of screening tools from a nurse-driven paper checklist to electronic health record-based real-time advisory are available, and the end goal of them all is for early detection possibly even at a pre-hospital stage by the emergency medical services. [9][10][11][12] In the age of information and analytics, modified early warning signs [13] and Rothman index [14] can be…”

Section: Diagnosis and Screeningmentioning

confidence: 99%

Sepsis Diagnosis and Management

Gotur¹

2017

JMSH

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Sepsis has a new definition, and it is defined as dysregulated host response and organ dysfunction due to infection. To clearly define and screen for organ dysfunction, sequential organ failure assessment (SOFA), and quick SOFA scoring system is recommended. Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a higher mortality risk. Sepsis incidence in India is under-reported. Inflammatory process and coagulation are closely linked in sepsis pathogenesis. Lactate measurement and its clearance are used both as a diagnosis and management tool for resuscitation in sepsis. Major recommendations by surviving sepsis campaign (SSC) for the management of sepsis are grouped in bundles of interventions. Recognition of golden hour in sepsis for early antibiotics and resuscitation is crucial. 30 cc/Kg crystalloid fluid bolus for septic shock should be infused within 3 h of triage or sepsis diagnosis. Fluid resuscitation in septic shock can be described in four stages -the rescue, optimization, stabilization, and evacuation phases. Instead of targeting distinct values of central venous pressure and mixed venous oxygen saturation, the SSC guidelines now recommend to re-assess volume status and tissue perfusion within 6-h by repeated focused exam and lactate clearance. The first line vasopressor recommended in septic shock is norepinephrine. For patients with sepsis-induced adult respiratory distress syndrome, using higher over lower positive end-expiratory pressure, lower over higher tidal volume setting on the mechanical ventilator, and prone positioning is recommended. A protocolized approach should be used for blood glucose management in patients with sepsis, commencing insulin dosing when two consecutive blood glucose levels are >180 mg/dL and maintaining upper blood glucose level ≤180 mg/dL rather than ≤110 mg/dL. Assessment of nutritional status using scoring systems such as NUTRIC score and NRS 2002 should be made, and early enteral trophic feeding should be initiated and advanced within 24-48 h. Any initiative designed to improve adherence to the sepsis guidelines and thus improve performance in sepsis core measures requires an institution-specific, strategic, and planned approach. A trans-disciplinary team charged with the functions of raising sepsis awareness, developing sepsis focused educational programs, establishing a care pathway model and monitoring compliance and adherence to the sepsis bundles can help improve the sepsis outcomes. Future focus in sepsis is on earlier recognition, newer screening tools, education among public and health-care workers and optimizing recovery.

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“…Numerous studies explored how sepsis could be detected as early as possible after presentation to the emergency department to prioritise treatment of these patients using computerised decision support systems 1,2 . NEWS, qSOFA, SIRS, Manchester Triage System, ATS (Australian Triage Scale), CATS (Canadian Acuity Triage Scale), and ESI (Emergency Severity Index) are among the most used scoring systems during triage, and there is a wide variation in diagnostic accuracy of these tools [3][4][5][6][7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Validity of a digital sepsis screening system combining the Manchester Triage System and a SIRS-based system for the detection of sepsis at triage in the emergency department

Dewitte

Scheurwegs

Ierssel

et al. 2022

Preprint

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Background and importanceDetection of sepsis in the emergency department (ED) should be done preferably during triage of the patients. The Manchester triage system (MTS) can be used to screen for sepsis. Objective To investigate the accuracy and validity of the MTS for detection of sepsis during triage in the ED and a combination of the MTS with a SIRS based digital sepsis screening system.DesignSingle center retrospective studySettings and participantsPatients presenting to an ED of a tertiary-care centre who received formal triage were included. (n=29766 patients). Outcome measures and analysisCalculated performance measures included sensitivity, specificity, likelihood ratios and AUC for detection of sepsis. Main resultsA total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 45 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5). Combining the MTS and the SIRS-based screening tool showed an improved sensitivity of 64.0% (95% CI 56.7 to 70.9) and a specificity of 96.8% (95% CI 96.4 to 96.8).

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Comparison of Sepsis Screening Tools' Ability to Detect Sepsis Accurately

Cited by 13 publications

References 7 publications

Protocol for a pilot randomized controlled trial comparing plasma with balanced crystalloid resuscitation in surgical and trauma patients with septic shock

Protocol for a pilot randomized controlled trial comparing plasma with balanced crystalloid resuscitation in surgical and trauma patients with septic shock

Sepsis Diagnosis and Management

Validity of a digital sepsis screening system combining the Manchester Triage System and a SIRS-based system for the detection of sepsis at triage in the emergency department

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