Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Acad Emerg Med. 2021 Jul;28(7):745-752. doi: 10.1111/acem.14265. Epub 2021 May 8.
Effective sepsis resuscitation depends on useful criteria for prompt identification of eligible patients. These criteria should reliably predict a discharge diagnosis of sepsis, ensuring that interventions are triggered for those who need it while avoiding potentially harmful interventions in those who do not. We sought to determine the proportion of patients meeting sepsis criteria in the emergency department (ED) that was ultimately diagnosed with sepsis and to quantify the subset of nonseptic patients with risk factors for harm from fluid resuscitation.
This retrospective cohort study of adult ED patients at a tertiary academic medical center included vital signs and laboratory results from the first 6 hours, plus administration of intravenous antibiotics, to determine if patients met 2016 Sepsis-3 consensus criteria. If these patients also had hypotension and lactic acidosis, we categorized them as Sepsis-3 plus shock. We used discharge ICD-9 codes to determine if patients were ultimately diagnosed with sepsis.
Over 8 years, 3,121 ED patients met 2016 Sepsis-3 criteria in the first 6 hours. Of these, only 25% and 48% met explicit and implicit criteria for a discharge diagnosis of sepsis. Of 1,032 patients with Sepsis-3 plus shock, 48% and 62% met explicit and implicit criteria. Overall, 60% to 75% of ED patients meeting Sepsis-3 criteria with or without shock did not receive a sepsis discharge diagnosis. At least one plausible risk factor for harm from large-volume fluid resuscitation was identified among 19% to 36% of patients meeting sepsis criteria in the ED but not ultimately diagnosed with sepsis at discharge.
Most patients meeting sepsis criteria in the ED were not diagnosed with sepsis at discharge. Urgent treatment bundles triggered by consensus criteria in the early phase of ED care may be administered to several patients without sepsis, potentially exposing some to interventions of uncertain benefit and possible harm.
有效的脓毒症复苏取决于有用的标准，以便及时识别合格的患者。这些标准应可靠地预测脓毒症的出院诊断，确保为需要的患者触发干预措施，同时避免对不需要的患者进行潜在的有害干预。我们旨在确定急诊科（ED）符合脓毒症标准的患者中最终被诊断为脓毒症的比例，并量化有液体复苏风险因素的非脓毒症患者亚组。
这是一项对三级学术医疗中心成人 ED 患者的回顾性队列研究，纳入了前 6 小时的生命体征和实验室结果，以及静脉抗生素的使用情况，以确定患者是否符合 2016 年脓毒症-3 共识标准。如果这些患者还存在低血压和乳酸酸中毒，则将其归类为脓毒症-3 合并休克。我们使用出院 ICD-9 代码来确定患者最终是否被诊断为脓毒症。
在 8 年期间，3121 名 ED 患者在前 6 小时内符合 2016 年脓毒症-3 标准。其中，只有 25%和 48%符合明确和隐含的出院诊断为脓毒症的标准。在 1032 名脓毒症-3 合并休克的患者中，48%和 62%符合明确和隐含的标准。总体而言，符合脓毒症-3 标准且无论是否存在休克的 ED 患者中，有 60%至 75%未被诊断为脓毒症出院。在急诊科符合脓毒症标准但最终未被诊断为脓毒症的患者中，有 19%至 36%至少有一个可能因大容量液体复苏而受到伤害的合理风险因素。
大多数在 ED 符合脓毒症标准的患者在出院时并未被诊断为脓毒症。在 ED 早期护理阶段，由共识标准触发的紧急治疗方案可能会对多名没有脓毒症的患者进行治疗，这可能会使一些患者面临不确定获益且可能有害的干预措施。
