qSOFA、SIRS 标准和脓毒症定义对识别院前环境和急诊科分诊中感染风险患者的并发症的敏感性较低。
Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage.
机构信息
Service of Internal Medicine, Department of Medicine, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, -1011, Lausanne, CH, Switzerland.
Emergency Department, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, -1011, Lausanne, CH, Switzerland.
出版信息
Scand J Trauma Resusc Emerg Med. 2017 Nov 3;25(1):108. doi: 10.1186/s13049-017-0449-y.
BACKGROUND
Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage.
METHODS
We performed a retrospective study of all patients transported by emergency medical services (EMS) to the Lausanne University Hospital (CHUV) over twelve months. All patients with a suspected or proven infection after the ED workup were included. We retrospectively analysed the sensitivity of the qSOFA score (≥2 criteria), SIRS criteria (≥2 clinical criteria) and sepsis definition (SIRS criteria + one sign of organ dysfunction or hypoperfusion) in the pre-hospital setting and at the ED triage as predictors of ICU admission, ICU stay of ≥3 days and early (i.e. 48 h) mortality. No direct comparison between the three tools was attempted.
RESULTS
Among 11,411 patients transported to the University hospital, 886 (7.8%) were included. In the pre-hospital setting, the sensitivity of qSOFA reached 36.3% for ICU admission, 17.4% for ICU stay of three days or more and 68.0% for 48 h mortality. The sensitivity of SIRS criteria reached 68.8% for ICU admission, 74.6% for ICU stay of three days or more and 64.0% for 48 h mortality. The sensitivity of sepsis definition did not reach 60% for any outcome. At ED triage, the sensitivity of qSOFA reached 31.2% for ICU admission, 30.5% for ICU stay of ≥3 days and 60.0% for mortality at 48 h. The sensitivity of SIRS criteria reached 58.8% for ICU admission, 57.6% for ICU stay of ≥3 days 80.0% for mortality at 48 h. The sensitivity of sepsis definition reached 60.0% for 48 h mortality.
DISCUSSION
Incidence of sepsis in the ED among patients transported by ambulance was 3.8 percent. This rate, associated to the mortality of sepsis, confirms the necessity to dispose of a test to early identify those patients.
CONCLUSION
The sensitivity performance of all three tools was suboptimal. The qSOFA score, SIRS criteria and sepsis definition have low identification sensitivity in selecting septic patients in the pre-hospital setting or upon arrival in the ED at risk of complication.
背景
败血症是指宿主对感染的反应引起的危及生命的器官功能障碍。最近提出了快速 SOFA（qSOFA）评分作为一种新的床边临床评分，用于识别有感染并发症风险（入住重症监护病房（ICU）、住院死亡率）的疑似感染患者。本研究的目的是测量 qSOFA 评分、SIRS 标准和败血症定义在院前和急诊分诊时识别最严重败血症病例的敏感性。
方法
我们对 12 个月内在洛桑大学医院（CHUV）通过紧急医疗服务（EMS）转运的所有患者进行了回顾性研究。所有经过 ED 检查后有疑似或确诊感染的患者均被纳入研究。我们回顾性分析了 qSOFA 评分（≥2 项标准）、SIRS 标准（≥2 项临床标准）和败血症定义（SIRS 标准+器官功能障碍或灌注不足的一个体征）在院前和 ED 分诊时作为预测 ICU 入住、ICU 入住≥3 天和早期（即 48 小时）死亡率的敏感性。未尝试对三种工具进行直接比较。
结果
在转运至大学医院的 11411 名患者中，有 886 名（7.8%）患者被纳入研究。在院前环境中，qSOFA 的敏感性为 ICU 入住 36.3%、ICU 入住≥3 天 17.4%、48 小时死亡率 68.0%。SIRS 标准的敏感性为 ICU 入住 68.8%、ICU 入住≥3 天 74.6%、48 小时死亡率 64.0%。败血症定义的敏感性未达到 60%。在 ED 分诊时，qSOFA 的敏感性为 ICU 入住 31.2%、ICU 入住≥3 天 30.5%、48 小时死亡率 60.0%。SIRS 标准的敏感性为 ICU 入住 58.8%、ICU 入住≥3 天 57.6%、48 小时死亡率 80.0%。败血症定义的敏感性为 48 小时死亡率 60.0%。
讨论
救护车转运至 ED 的败血症患者发生率为 3.8%。这一发生率加上败血症的死亡率证实了需要有一种检测方法来尽早识别那些患者。
结论
所有三种工具的敏感性表现均不理想。qSOFA 评分、SIRS 标准和败血症定义在院前环境或在 ED 就诊时选择有并发症风险的败血症患者时，识别敏感性较低。
Zotero 插件