脓毒症的定义：探寻黄金标准以及医疗保险和医疗补助服务中心的错误之处
Sepsis Definitions: The Search for Gold and What CMS Got Wrong.
作者信息
Kalantari Annahieta, Mallemat Haney, Weingart Scott D
机构信息
Aria Jefferson Health, Department of Emergency Medicine, Philadelphia, Pennsylvania.
Philadelphia College of Osteopathic Medicine, Department of Emergency Medicine, Philadelphia, Pennsylvania.
出版信息
West J Emerg Med. 2017 Aug;18(5):951-956. doi: 10.5811/westjem.2017.4.32795. Epub 2017 Jul 10.
Abstract
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a core measure addressing the care of septic patients. These core measures are controversial among healthcare providers. This article will address that there is no gold standard definition for sepsis, severe sepsis or septic shock and the CMS-assigned definitions for severe sepsis and septic shock are premature and inconsistent with evidence-based definitions.
摘要
2015年10月1日，美国医疗保险和医疗补助服务中心（CMS）发布了一项针对脓毒症患者护理的核心指标。这些核心指标在医疗服务提供者中存在争议。本文将指出，对于脓毒症、严重脓毒症或脓毒性休克，不存在金标准定义，且CMS对严重脓毒症和脓毒性休克所指定的定义为时过早，与循证定义不一致。
相似文献
1
Sepsis Definitions: The Search for Gold and What CMS Got Wrong.脓毒症的定义：探寻黄金标准以及医疗保险和医疗补助服务中心的错误之处
West J Emerg Med. 2017 Aug;18(5):951-956. doi: 10.5811/westjem.2017.4.32795. Epub 2017 Jul 10.
2
The Past, Present, and Future of the Centers for Medicare and Medicaid Services Quality Measure SEP-1: The Early Management Bundle for Severe Sepsis/Septic Shock.医疗保险和医疗补助服务中心质量指标SEP-1的过去、现在与未来：严重脓毒症/脓毒症休克的早期管理综合方案
Emerg Med Clin North Am. 2017 Feb;35(1):219-231. doi: 10.1016/j.emc.2016.09.006.
3
Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1).医疗保险和医疗补助服务中心严重脓毒症及脓毒性休克管理集束方案（SEP-1）的支撑证据。
Ann Intern Med. 2018 Apr 17;168(8):609-610. doi: 10.7326/L18-0139.
4
Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach.院前护理人员启动的脓毒症核心测量集：一种逐步方法。
Prehosp Emerg Care. 2017 May-Jun;21(3):291-300. doi: 10.1080/10903127.2016.1254694. Epub 2016 Dec 5.
5
New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field.医疗保险和医疗补助服务中心关于脓毒症报告的新强制要求：来自实际工作的警示
J Emerg Med. 2017 Jan;52(1):109-116. doi: 10.1016/j.jemermed.2016.08.009. Epub 2016 Oct 5.
6
Review: sepsis guidelines and core measure bundles.综述：脓毒症指南和核心措施包。
Postgrad Med. 2024 Sep;136(7):702-711. doi: 10.1080/00325481.2024.2388021. Epub 2024 Aug 7.
7
Moving Beyond the Centers for Medicare and Medicaid Services' "Severe Sepsis and Septic Shock Early Management Bundle" Core Quality Measure.超越医疗保险和医疗补助服务中心的“严重脓毒症和脓毒性休克早期管理集束化治疗”核心质量指标。
Ann Emerg Med. 2021 Jul;78(1):20-26. doi: 10.1016/j.annemergmed.2021.03.003. Epub 2021 May 4.
8
Comparison of Sepsis Definitions as Automated Criteria.作为自动化标准的脓毒症定义比较。
Crit Care Med. 2021 Apr 1;49(4):e433-e443. doi: 10.1097/CCM.0000000000004875.
9
Infectious Diseases Society of America Position Paper: Recommended Revisions to the National Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Sepsis Quality Measure.美国传染病学会立场文件：国家严重脓毒症和脓毒性休克早期管理捆绑包（SEP-1）脓毒症质量测量推荐修订版。
Clin Infect Dis. 2021 Feb 16;72(4):541-552. doi: 10.1093/cid/ciaa059.
10
Evidence Underpinning the Centers for Medicare & Medicaid Services' Severe Sepsis and Septic Shock Management Bundle (SEP-1).医疗保险和医疗补助服务中心严重脓毒症及脓毒性休克管理集束方案（SEP-1）的支撑证据
Ann Intern Med. 2018 Apr 17;168(8):610-612. doi: 10.7326/L18-0140.
引用本文的文献
1
Reformulating patient stratification for targeting interventions by accounting for severity of downstream outcomes resulting from disease onset: a case study in sepsis.通过考虑疾病发作导致的下游结果的严重程度来重新制定患者分层以进行靶向干预：脓毒症的案例研究
J Am Med Inform Assoc. 2025 May 1;32(5):905-913. doi: 10.1093/jamia/ocaf036.
2
Sepsis mortality and ICU length of stay after the implementation of an intensive care team in the emergency department.在急诊科实施重症监护团队后，脓毒症的死亡率和 ICU 住院时间。
Intern Emerg Med. 2023 Sep;18(6):1789-1796. doi: 10.1007/s11739-023-03265-0. Epub 2023 Apr 19.
3
Educational needs assessment identifying opportunities to improve sepsis care.教育需求评估确定改善脓毒症护理的机会。
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2022-001930.
4
Varying Estimates of Sepsis among Adults Presenting to US Emergency Departments: Estimates from a National Dataset from 2002-2018.美国急诊科成人脓毒症的估计值各不相同：来自 2002-2018 年国家数据集的估计值。
J Intensive Care Med. 2022 Nov;37(11):1451-1459. doi: 10.1177/08850666221080060. Epub 2022 Feb 28.
5
Age-adjusted and Expanded Lactate Thresholds as Predictors of All-Cause Mortality in the Emergency Department.年龄调整和扩展的乳酸阈值可预测急诊科的全因死亡率。
West J Emerg Med. 2020 Aug 20;21(5):1249-1257. doi: 10.5811/westjem.2020.5.46811.
6
Sepsis Alerts in Emergency Departments: A Systematic Review of Accuracy and Quality Measure Impact.急诊科脓毒症预警：准确性和质量测量影响的系统评价。
West J Emerg Med. 2020 Aug 24;21(5):1201-1210. doi: 10.5811/westjem.2020.5.46010.
7
Retrospective Observational Study of the Clinical Performance Characteristics of a Machine Learning Approach to Early Sepsis Identification.机器学习方法用于早期脓毒症识别的临床性能特征的回顾性观察研究
Crit Care Explor. 2019 Sep 13;1(9):e0046. doi: 10.1097/CCE.0000000000000046. eCollection 2019 Sep.
8
Sepsis 2019: What Surgeons Need to Know.Sepsis 2019：外科医生需要了解的知识。
Surg Infect (Larchmt). 2020 Apr;21(3):195-204. doi: 10.1089/sur.2019.126. Epub 2019 Nov 22.
9
Sepsis in the era of data-driven medicine: personalizing risks, diagnoses, treatments and prognoses.数据驱动医学时代的脓毒症：个体化风险、诊断、治疗和预后。
Brief Bioinform. 2020 Jul 15;21(4):1182-1195. doi: 10.1093/bib/bbz059.
10
Sepsis and antimicrobial stewardship: two sides of the same coin.脓毒症与抗菌药物管理：同一枚硬币的两面。
BMJ Qual Saf. 2019 Sep;28(9):758-761. doi: 10.1136/bmjqs-2019-009445. Epub 2019 Apr 24.
本文引用的文献
1
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.拯救脓毒症运动：脓毒症与脓毒性休克管理国际指南：2016版
Crit Care Med. 2017 Mar;45(3):486-552. doi: 10.1097/CCM.0000000000002255.
2
Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit.快速脓毒症相关器官功能衰竭评估、全身炎症反应综合征及早期预警评分用于检测重症监护病房以外感染患者的临床病情恶化
Am J Respir Crit Care Med. 2017 Apr 1;195(7):906-911. doi: 10.1164/rccm.201604-0854OC.
3
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).《脓毒症及脓毒性休克第三次国际共识定义（脓毒症-3）》
JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
4
Lactate Clearance Predicts Survival Among Patients in the Emergency Department with Severe Sepsis.乳酸清除率可预测急诊科严重脓毒症患者的生存率。
West J Emerg Med. 2015 Dec;16(7):1118-26. doi: 10.5811/westjem.2015.10.27577. Epub 2015 Dec 8.
5
Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values.针对脓毒症和中度乳酸值患者的治疗集束方案的多中心实施
Am J Respir Crit Care Med. 2016 Jun 1;193(11):1264-70. doi: 10.1164/rccm.201507-1489OC.
6
Trial of early, goal-directed resuscitation for septic shock.早期目标导向性复苏治疗脓毒性休克的试验。
N Engl J Med. 2015 Apr 2;372(14):1301-11. doi: 10.1056/NEJMoa1500896. Epub 2015 Mar 17.
7
Goal-directed resuscitation for patients with early septic shock.目标导向性复苏治疗早期感染性休克患者。
N Engl J Med. 2014 Oct 16;371(16):1496-506. doi: 10.1056/NEJMoa1404380. Epub 2014 Oct 1.
8
Clinical predictors of adverse outcome in severe sepsis patients with lactate 2-4 mM admitted to the hospital.入院时血乳酸浓度为 2-4mM 的严重脓毒症患者不良预后的临床预测因子。
QJM. 2015 Apr;108(4):279-87. doi: 10.1093/qjmed/hcu186. Epub 2014 Sep 4.
9
A randomized trial of protocol-based care for early septic shock.一项基于方案的早期脓毒性休克护理的随机试验。
N Engl J Med. 2014 May 1;370(18):1683-93. doi: 10.1056/NEJMoa1401602. Epub 2014 Mar 18.
10
Fluid balance and cardiac function in septic shock as predictors of hospital mortality.脓毒性休克中的液体平衡和心脏功能作为医院死亡率的预测指标
Crit Care. 2013 Oct 20;17(5):R246. doi: 10.1186/cc13072.
Zotero 插件