Challenges and Opportunities for Emergency Department Sepsis Screening at Triage
Author(s)Filbin, Michael R.; Thorsen, Jill E.; Lynch III, James Charles; Gillingham, Trent D.; Pasakarnis, Corey L.; Capp, Roberta; Shapiro, Nathan I.; Mooncai, Theodore; Hou, Peter C.; Heldt, Thomas; Reisner, Andrew T.; ... Show more Show less
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Feasibility of ED triage sepsis screening, before diagnostic testing has been performed, has not been established. In a retrospective, outcome-blinded chart review of a one-year cohort of ED adult septic shock patients (“derivation cohort”) and three additional, non-consecutive months of all adult ED visits (“validation cohort”), we evaluated the qSOFA score, the Shock Precautions on Triage (SPoT) vital-signs criterion, and a triage concern-for-infection (tCFI) criterion based on risk factors and symptoms, to screen for sepsis. There were 19,670 ED patients in the validation cohort; 50 developed ED septic shock, of whom 60% presented without triage hypotension, and 56% presented with non-specific symptoms. The tCFI criterion improved specificity without substantial reduction of sensitivity. At triage, sepsis screens (positive qSOFA vital-signs and tCFI, or positive SPoT vital-signs and tCFI) were 28% (95% CI: 16–43%) and 56% (95% CI: 41–70%) sensitive, respectively, p < 0.01. By the conclusion of the ED stay, sensitivities were 80% (95% CI: 66–90%) and 90% (95% CI: 78–97%), p > 0.05, and specificities were 97% (95% CI: 96–97%) and 95% (95% CI: 95–96%), p < 0.001. ED patients who developed septic shock requiring vasopressors often presented normotensive with non-specific complaints, necessitating a low threshold for clinical concern-for-infection at triage.
DepartmentMassachusetts Institute of Technology. Center for Biomedical Engineering; Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science
Springer Science and Business Media LLC
Filbin, Michael R. et al. "Challenges and Opportunities for Emergency Department Sepsis Screening at Triage." Scientific Reports 8, 1 (July 2018): 11059 © 2018 The Author(s)
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