Suttapanit Karn, Dangprasert Kamonwan, Sanguanwit Pitsucha, Supatanakij Praphaphorn
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Int J Emerg Med. 2022 May 10;15(1):18. doi: 10.1186/s12245-022-00420-w.
Administration of antibiotics to septic patients within 1 h was recommended in 2018 by the Surviving Sepsis Campaign (SSC) as a strategy to improve survival outcomes. The use of sepsis screening tools in emergency departments (EDs) is important for early diagnosis and initiation of sepsis care. This study aimed to assess the impact of the Ramathibodi early warning score (REWs) on the administration of antibiotics within 1 h of presentation.
This was an observational retrospective cohort study with propensity score matching between the sepsis-3 criteria (pre-period) and the REWs (post-period) as screening tools in adult patients with sepsis in EDs. The primary outcome was the proportion of receiving antibiotics within 1 h of presentation in the pre- and post-periods.
A total of 476 patients were analyzed without propensity matching. The proportion of antibiotic administration within 1 h was higher in patients screened using the REWs compared with standard of care in the total study population (79.5% vs. 61.4%, p < 0.001). After propensity score matching, 153 patients were included in both groups. The proportion of antibiotic administration within 1 h was similar in patients screened using the REWs and those receiving standard of care (79.7% vs. 80.4%, p = 0.886). However, time to intensive care unit (ICU) admission was faster in patients screened using the REWs. Delays in receiving antibiotics of longer than 3 h were associated with increased mortality (adjusted hazard ratio 7.04, 95% confidence interval 1.45 to 34.11, p = 0.015).
Implementing the REWs as a tool in sepsis screening protocols in EDs did not improve rates of antibiotic administration within 1 h as recommended by the SSC. However, time to ICU admission was improved after implementation of the REWs.
2018年，拯救脓毒症运动（SSC）建议在1小时内对脓毒症患者使用抗生素，作为改善生存结果的一项策略。在急诊科（ED）使用脓毒症筛查工具对于脓毒症的早期诊断和治疗启动很重要。本研究旨在评估拉玛蒂博迪早期预警评分（REWs）对患者就诊1小时内使用抗生素的影响。
这是一项观察性回顾性队列研究，对急诊科成年脓毒症患者使用脓毒症-3标准（前期）和REWs（后期）作为筛查工具进行倾向得分匹配。主要结局是前期和后期患者就诊1小时内接受抗生素治疗的比例。
共分析了476例未进行倾向得分匹配的患者。在整个研究人群中，使用REWs筛查的患者1小时内使用抗生素的比例高于标准治疗组（79.5%对61.4%，p<0.001）。倾向得分匹配后，两组各纳入153例患者。使用REWs筛查的患者和接受标准治疗的患者1小时内使用抗生素的比例相似（79.7%对80.4%，p = 0.886）。然而，使用REWs筛查的患者入住重症监护病房（ICU）的时间更快。抗生素使用延迟超过3小时与死亡率增加相关（调整后的风险比为7.04，95%置信区间为1.45至34.11，p = 0.015）。
在急诊科脓毒症筛查方案中使用REWs作为工具，并未如SSC所建议的那样提高1小时内抗生素的使用比例。然而，实施REWs后，患者入住ICU的时间有所改善。
