紧接着发生脓毒症住院前的就诊特征和结局。
Characteristics and Outcomes of Clinic Visits Immediately Preceding Sepsis Hospitalization.
机构信息
H. Catherine Miller is a former internal medicine resident physician, University of Michigan, Ann Arbor. She is now an assistant professor of clinical medicine at Vanderbilt University Medical Center, Nashville, Tennessee.
Vincent X. Liu is a research scientist, Kaiser Permanente Northern California Division of Research, Oakland, California and an intensivist, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California.
出版信息
Am J Crit Care. 2021 Mar 1;30(2):135-139. doi: 10.4037/ajcc2021456.
BACKGROUND
Existing sepsis quality improvement initiatives focus on recognition and treatment of sepsis upon hospital admission. Yet many patients are evaluated in the clinic within 1 day of sepsis hospitalization.
OBJECTIVES
To determine the circumstances of clinic visits that precede sepsis hospitalization, including illness severity, whether patients are referred to the hospital, and time lapse and change in illness severity between clinic and hospital evaluation.
METHODS
In a retrospective cohort study at a tertiary academic medical center, data from electronic medical records were collected for all adult patients evaluated in an outpatient clinic within 1 day of sepsis hospitalization in 2017.
RESULTS
Of 1450 patients hospitalized with sepsis, 118 had an established outpatient provider and a clinic visit within 1 day of admission and thus were included. During the clinic visit, 47 patients (39.8%) had a quick Sequential Organ Failure Assessment (qSOFA) score ≥1, and 59 (50.0%) had vital sign abnormalities. Most (74, 62.7%) were sent directly to the emergency department or hospital. Upon emergency department/hospital presentation, 62 patients (52.5%) had a worsening qSOFA score and/ or vital signs and 27 (22.9%) had worsening of multiple parameters. Median time lapse from clinic to emergency department/hospital evaluation was 3.2 hours.
CONCLUSIONS
One in 10 patients hospitalized for sepsis had been evaluated in a clinic within 1 day of admission. At that clinic visit, most patients had an elevated qSOFA score or abnormal vital signs and a majority were sent directly to the emergency department/hospital. Half experienced clinical deterioration between the clinic visit and arrival in the emergency department/hospital.
背景
现有的脓毒症质量改进计划侧重于在入院时识别和治疗脓毒症。然而，许多患者在脓毒症住院后 1 天内就在诊所接受评估。
目的
确定在脓毒症住院前的诊所就诊情况，包括疾病严重程度、患者是否被转诊到医院，以及在诊所和医院评估之间的时间差和疾病严重程度的变化。
方法
在一家三级学术医疗中心的回顾性队列研究中，收集了 2017 年所有在脓毒症住院后 1 天内在门诊就诊的成年患者的电子病历数据。
结果
在 1450 例脓毒症住院患者中，有 118 例患者在住院前 1 天内有固定的门诊医生，并进行了门诊就诊，因此被纳入研究。在诊所就诊期间，有 47 例（39.8%）患者的快速序贯器官衰竭评估（qSOFA）评分≥1，59 例（50.0%）患者有生命体征异常。大多数患者（74 例，62.7%）被直接送往急诊科或医院。在急诊科/医院就诊时，有 62 例（52.5%）患者的 qSOFA 评分和/或生命体征恶化，27 例（22.9%）患者的多个参数恶化。从诊所到急诊科/医院评估的中位时间差为 3.2 小时。
结论
每 10 例因脓毒症住院的患者中，就有 1 例在入院后 1 天内接受过诊所评估。在该次诊所就诊时，大多数患者的 qSOFA 评分或生命体征异常升高，大多数患者被直接送往急诊科/医院。一半的患者在诊所就诊和到达急诊科/医院之间出现了临床恶化。
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