Kraus Chadd K, Nguyen H Bryant, Jacobsen Ryan C, Ledeboer Nathan A, May Larissa S, O'Neal Hollis R, Puskarich Michael A, Rice Todd W, Self Wesley H, Rothman Richard E
Department of Emergency Medicine Geisinger Medical Center Danville Pennsylvania USA.
Department of Medicine Pulmonary and Critical Care Division Loma Linda University Loma Linda California USA.
J Am Coll Emerg Physicians Open. 2023 Jun 3;4(3):e12984. doi: 10.1002/emp2.12984. eCollection 2023 Jun.
Recent research has helped define the complex pathways in sepsis, affording new opportunities for advancing diagnostics tests. Given significant advances in the field, a group of academic investigators from emergency medicine, intensive care, pathology, and pharmacology assembled to develop consensus around key gaps and potential future use for emerging rapid host response diagnostics assays in the emergency department (ED) setting.
A modified Delphi study was conducted that included 26 panelists (expert consensus panel) from multiple specialties. A smaller steering committee first defined a list of Delphi statements related to the need for and future potential use of a hypothetical sepsis diagnostic test in the ED. Likert scoring was used to assess panelists agreement or disagreement with statements. Two successive rounds of surveys were conducted and consensus for statements was operationally defined as achieving agreement or disagreement of 75% or greater.
Significant gaps were identified related to current tools for assessing risk of sepsis in the ED. Strong consensus indicated the need for a test providing an indication of the severity of dysregulated host immune response, which would be helpful even if it did not identify the specific pathogen. Although there was a relatively high degree of uncertainty regarding which patients would most benefit from the test, the panel agreed that an ideal host response sepsis test should aim to be integrated into ED triage and thus should produce results in less than 30 minutes. The panel also agreed that such a test would be most valuable for improving sepsis outcomes and reducing rates of unnecessary antibiotic use.
The expert consensus panel expressed strong consensus regarding gaps in sepsis diagnostics in the ED and the potential for new rapid host response tests to help fill these gaps. These finding provide a baseline framework for assessing key attributes of evolving host response diagnostic tests for sepsis in the ED.
近期研究有助于明确脓毒症的复杂发病机制，为改进诊断检测提供了新机遇。鉴于该领域取得的重大进展，一群来自急诊医学、重症监护、病理学和药理学的学术研究人员齐聚一堂，围绕急诊室（ED）环境中新兴的快速宿主反应诊断检测的关键差距和未来潜在用途达成共识。
开展了一项改良的德尔菲研究，其中包括来自多个专业的26名小组成员（专家共识小组）。一个规模较小的指导委员会首先确定了一系列与急诊室中假设的脓毒症诊断检测的必要性和未来潜在用途相关的德尔菲陈述。采用李克特评分法评估小组成员对陈述的同意或不同意程度。进行了两轮连续调查，陈述的共识在操作上被定义为达成75%或更高的同意或不同意率。
确定了与急诊室目前评估脓毒症风险的工具相关的重大差距。强烈的共识表明需要一种能够指示宿主免疫反应失调严重程度的检测方法，即使它不能识别特定病原体也会有所帮助。尽管对于哪些患者将从该检测中获益最大存在相对较高的不确定性，但小组一致认为，理想的宿主反应脓毒症检测应旨在纳入急诊分诊，因此应在30分钟内得出结果。小组还一致认为，这样的检测对于改善脓毒症治疗结果和降低不必要的抗生素使用率最有价值。
专家共识小组对急诊室脓毒症诊断的差距以及新的快速宿主反应检测有助于填补这些差距的潜力表达了强烈的共识。这些发现为评估急诊室中不断发展的脓毒症宿主反应诊断检测的关键属性提供了一个基线框架。
