Emergency Department, The Second Affiliated Hospital of Guangzhou Medical University, China; Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China.
Am J Emerg Med. 2018 Jun;36(6):988-992. doi: 10.1016/j.ajem.2017.11.007. Epub 2017 Nov 3.
The diagnosis of shock in patients presenting to the emergency department (ED) is often challenging. We aimed to compare the accuracy of experienced emergency physician gestalt against Li's pragmatic shock (LiPS) tool for predicting the likelihood of shock in the emergency department, using 30-day mortality as an objective standard.
In a prospective observational study conducted in an urban, academic ED in Hong Kong, adult patients aged 18years or older admitted to the resuscitation room or high dependency unit were recruited. Eligible patients had a standard ED workup for shock. The emergency physician treating the patient was asked whether he or she considered shock to be probable, and this was compared with LiPS. The proxy 'gold' or reference standard was 30-day mortality. The area under the receiver operating curve (AUROC) was used to predict prognosis. The primary outcome measure was 30-day mortality.
A total of 220 patients fulfilled the inclusion criteria and were included in the analysis. The AUROC for LiPS (0.722; sensitivity=0.733, specificity=0.711, P<0.0001) was greater than emergency physician gestalt (0.620, sensitivity=0.467, specificity=0.774, P=0.0137) for diagnosing shock using 30-day mortality as a proxy (difference P=0.0229). LiPS shock patients were 6.750 times (95%CI=2.834-16.076, P<0.0001) more likely to die within 30-days compared with non-shock patients. Patients diagnosed by emergency physicians were 2.991 times (95%CI=1.353-6.615, P=0.007) more likely to die compared with the same reference.
LiPS has a higher diagnostic accuracy than emergency physician gestalt for shock when compared against an outcome of 30-day mortality.
急诊科（ED）就诊患者休克的诊断往往具有挑战性。我们旨在比较经验丰富的急诊医师整体判断与 Li 的实用休克（LiPS）工具对预测 ED 休克可能性的准确性，以 30 天死亡率为客观标准。
在香港一家城市学术 ED 进行的前瞻性观察研究中，招募了年龄在 18 岁或以上、收入复苏室或高依赖病房的成年患者。符合条件的患者接受了休克标准 ED 检查。询问治疗患者的急诊医师是否认为休克可能性大，并与 LiPS 进行比较。代理“金标准”或参考标准为 30 天死亡率。使用受试者工作特征曲线（AUROC）下面积来预测预后。主要结局指标为 30 天死亡率。
共有 220 名患者符合纳入标准并纳入分析。LiPS 的 AUROC（0.722；敏感性=0.733，特异性=0.711，P<0.0001）大于急诊医师整体判断（0.620，敏感性=0.467，特异性=0.774，P=0.0137），以 30 天死亡率为替代指标（差异 P=0.0229）诊断休克。LiPS 休克患者在 30 天内死亡的可能性是无休克患者的 6.750 倍（95%CI=2.834-16.076，P<0.0001）。与同一参考标准相比，被急诊医师诊断的患者死亡的可能性高 2.991 倍（95%CI=1.353-6.615，P=0.007）。
与 30 天死亡率的结果相比，LiPS 对休克的诊断准确性高于急诊医师整体判断。
