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急诊科对疑似严重脓毒症和脓毒性休克的分诊筛查工具的评估。

Evaluation of an emergency department triage screening tool for suspected severe sepsis and septic shock.

作者信息

Patocka Catherine, Turner Joel, Xue Xiaoqing, Segal Eli

出版信息

J Healthc Qual. 2014 Jan-Feb;36(1):52-61; quiz 59-61. doi: 10.1111/jhq.12055.

Abstract

Early identification of septic patients is important to prevent delays in appropriate management. To improve detection of septic patients presenting to the emergency department (ED), we implemented a triage screening tool. Our study sought to determine the effect of this tool on time to antibiotics in patients with suspected severe sepsis or septic shock presenting to the ED. This was a retrospective chart review examining the time interval to antibiotics pre- and postimplementation of the triage tool. Multiple linear regression analyses were conducted to evaluate the effect of the triage tool on time to antibiotics while controlling for the effect of level of triage. We identified 185 patients with severe sepsis or septic shock in the pretriage tool group and 170 patients in the posttriage tool group. The mean time (in minutes) to antibiotics (±SD) in the pre- and postcohorts was 283 (±213) and 207 (±150), respectively. The multivariable analysis showed that the mean time to antibiotics decreased by 21% (95% CI 6-36%, p < .0074) comparing pre- versus posttriage tool implementation. The use of a sepsis triage screening tool significantly decreased the time to antibiotics in patients presenting to the ED with suspected severe sepsis or septic shock.

摘要

早期识别脓毒症患者对于防止适当治疗的延误至关重要。为了提高对急诊科(ED)就诊的脓毒症患者的检测率,我们实施了一种分诊筛查工具。我们的研究旨在确定该工具对疑似严重脓毒症或脓毒性休克的急诊科患者使用抗生素时间的影响。这是一项回顾性病历审查,检查分诊工具实施前后使用抗生素的时间间隔。进行了多元线性回归分析,以评估分诊工具对使用抗生素时间的影响,同时控制分诊级别的影响。我们在分诊前工具组中识别出185例严重脓毒症或脓毒性休克患者,在分诊后工具组中识别出170例患者。前后队列中使用抗生素的平均时间(分钟,±标准差)分别为283(±213)和207(±150)。多变量分析显示,与分诊工具实施前相比,使用抗生素的平均时间减少了21%(95%CI 6-36%,p<.0074)。使用脓毒症分诊筛查工具显著缩短了疑似严重脓毒症或脓毒性休克的急诊科患者使用抗生素的时间。

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