Validating a pragmatic definition of shock in adult patients presenting to the ED

Gestalt for shock and mortality in the emergency department: A prospective study

“…We have developed a pragmatic tool for shock assessment whereby cold peripheries usually suggest vasoconstrictive shock and warm peripheries suggest vasodilatory shock. Although this association is not absolute, in our previous study [3] we found that this categorization did equate to very different mortality outcomes. There are undoubtedly exceptions to this rule whereby cold hands equate to vasoconstriction and warm hands equate to vasodilatation.…”

“…Two cohorts of data were collected for the present study, 111 patients from the original publication [3] and a further 109 patients from a subsequent unpublished dataset.…”

“…According to LiPS, patients were first classified into one of three groups: no, possible or probable shock. In the probable shock group, patients were further divided according to peripheral (hand) temperature -cold, warm or hot peripheries [3,12].…”

“…Shock is often difficult to diagnose in the emergency department (ED) and delays in recognition and treatment adversely affect patient survival [1,2]. At the bedside, doctors identify shock using clinical history, health status, vital signs, examination, and easily available investigations such as urine output and blood lactate [3,4]. Appling a clinical diagnostic algorithm using these components which are generated based on the physician expertise is a way to improve diagnostic accuracy [5,6].…”

“…This strategy consists of the following components, systolic blood pressure (SBP), mean arterial pressure (MAP), clinical impression of tissue perfusion, blood lactate, pH and base deficit. Furthermore, when shock presents, the patient is classified according to peripheral skin temperature (see Table 1) [3]. When applying this novel protocol in the clinical setting, we need to demonstrate that it is at least as good as clinical gestalt, if not better.…”