التفاصيل البيبلوغرافية
| العنوان: |
An Emergency Department Validation of the SEP-3 Sepsis and Septic Shock Definitions and Comparison With 1992 Consensus Definitions. |
| المؤلفون: |
Henning, Daniel J., Puskarich, Michael A., Self, Wesley H., Howell, Michael D., Donnino, Michael W., Yealy, Donald M., Jones, Alan E., Shapiro, Nathan I. |
| المصدر: |
Annals of Emergency Medicine; Oct2017, Vol. 70 Issue 4, p544-552.e5, 1p |
| مصطلحات موضوعية: |
VASOCONSTRICTORS, COMPARATIVE studies, CONSENSUS (Social sciences), HEALTH status indicators, HOSPITAL emergency services, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, NOSOLOGY, POLICY sciences, RESEARCH, RESEARCH funding, EVALUATION research, SEPSIS, DIAGNOSIS, THERAPEUTICS |
| مستخلص: |
Study Objective: The Third International Consensus Definitions Task Force (SEP-3) proposed revised criteria defining sepsis and septic shock. We seek to evaluate the performance of the SEP-3 definitions for prediction of inhospital mortality in an emergency department (ED) population and compare the performance of the SEP-3 definitions to that of the previous definitions.Methods: This was a secondary analysis of 3 prospectively collected, observational cohorts of infected ED subjects aged 18 years or older. The primary outcome was all-cause inhospital mortality. In accordance with the SEP-3 definitions, we calculated test characteristics of sepsis (quick Sequential Organ Failure Assessment [qSOFA] score ≥2) and septic shock (vasopressor dependence plus lactate level >2.0 mmol/L) for mortality and compared them to the original 1992 consensus definitions.Results: We identified 7,754 ED patients with suspected infection overall; 117 had no documented mental status evaluation, leaving 7,637 patients included in the analysis. The mortality rate for the overall population was 4.4% (95% confidence interval [CI] 3.9% to 4.9%). The mortality rate for patients with qSOFA score greater than or equal to 2 was 14.2% (95% CI 12.2% to 16.2%), with a sensitivity of 52% (95% CI 46% to 57%) and specificity of 86% (95% CI 85% to 87%) to predict mortality. The original systemic inflammatory response syndrome-based 1992 consensus sepsis definition had a 6.8% (95% CI 6.0% to 7.7%) mortality rate, sensitivity of 83% (95% CI 79% to 87%), and specificity of 50% (95% CI 49% to 51%). The SEP-3 septic shock mortality was 23% (95% CI 16% to 30%), with a sensitivity of 12% (95% CI 11% to 13%) and specificity of 98.4% (95% CI 98.1% to 98.7%). The original 1992 septic shock definition had a 22% (95% CI 17% to 27%) mortality rate, sensitivity of 23% (95% CI 18% to 28%), and specificity of 96.6% (95% CI 96.2% to 97.0%).Conclusion: Both the new SEP-3 and original sepsis definitions stratify ED patients at risk for mortality, albeit with differing performances. In terms of mortality prediction, the SEP-3 definitions had improved specificity, but at the cost of sensitivity. Use of either approach requires a clearly intended target: more sensitivity versus specificity. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Supplemental Index |
