Very interesting! may i ask you how old ( average !) were your pts? andrea de gasperi
----- Messaggio originale ----- Da: "Anja Kathrina Jaehne" <[email protected]> A: "[email protected]" <[email protected]> Inviato: Venerdì, 30 settembre 2016 19:08:47 Oggetto: Re: [Sepsis Groups] SIRS+organ dysfunction vs. qSOFA/SOFA Please see below some retrospective comparisons regarding Emergency Department Triage assessments in concerns to qSOFA and SIRS criteria (August 2015- June 2016). These values are only in consideration of Triage for q SOFA and SIRS for patients who are retrospectively clearly identified as having either severe sepsis or septic shock. I would not be able to comment on specificity or sensitivity in the larger undifferentiated ED patient population at triage. TRIAGE ED qSOFA (Hypotension SBP< 100 mmHg; Respiratory Rate >/ = 22 breath/ min; Mental status changes) qSOFA 0 or 1 at Triage qSOFA 2 or 3 at Triage All Patients 260/382 (68%) 122/382 (32 %) Severe Sepsis Patients 150/192 (78%) 42/192 (22 %) Septic Shock patients 110/190 (58 %) 80/190 (42 %) The above data for our ED would mean, that if we would do a qSOFA assessment only once at triage and would base further clinical decisions on this, we may miss 58 – 78 % of patients with severe sepsis or septic shock. However qSOFA is not intended as singular assessment ! But I agree with what was said: it does not provide a sensitive initial screening assessment tool for the ED setting. Especially the assessment of mental status changes in the ED setting appears to be difficult particular in patients who are new to the ED, have no family or on certain medications. The GCS is often normal even when other mental alterations may be present but not documented not even recognized in the ED setting! I can see that in the ICU setting it may be easier to recognize mental status changes in patients which are known to the treatment teams. This is often not possible in the ED! TRIAGE ED SIRS (HR > 90 bpm, RR >/=20, Temp <36 C or > 38 C, WBC <4 or > 12 or bandemia >10) 0 or 1 SIRS 2 or more SIRS All Patients 48/382 (13 %) 334/382 (87 %) Severe Sepsis Patients 27/192 (14 %) 165/192 (86 %) Septic Shock Patients 21/190 (11 %) 169/190 (89 %) When we use TRIAGE SIRS criteria on the same patients who were assessed with qSOFA in the ED, and which have been later by chart review confirmed to have severe sepsis or septic shock, we are less likely to underestimate the potential risk of sepsis in these patients. My five cents: The qSOFA may be a tool for the continued ICU screening for septic patients. It may be not such a good tool in the ED triage setting. From our observational data it appears to me that SIRS criteria do exactly what Dr Bone had in mind: Identify patients with potential sepsis EARLY. SIRS criteria are not bulled proof, but they currently appear at ED triage the better initial tool to use to use when screening for patients at risk for severe sepsis or septic shock! Hopefully we will have further data soon to have a more prospective validation of qSOFA as a screening tool for sepsis in the ED! Maybe qSOFA performs better in the ICU!? Anyone what to share their data? Kathrina Anja Kathrin Jaehne, MD Clinical Research Coordinator Department of Emergency Medicine Henry Ford Hospital, Detroit MI 48202 [email protected] CONFIDENTIALITY NOTICE: This email contains information from the sender that may be CONFIDENTIAL, LEGALLY PRIVILEGED, PROPRIETARY or otherwise protected from disclosure. This email is intended for use only by the person or entity to whom it is addressed. If you are not the intended recipient, any use, disclosure, copying, distribution, printing, or any action taken in reliance on the contents of this email, is strictly prohibited. If you received this email in error, please contact the sending party by reply email, delete the email from your computer system and shred any paper copies. Note to Patients: There are a number of risks you should consider before using e-mail to communicate with us. See our Privacy & Security page on www.henryford.com for more detailed information as well as information concerning MyChart, our new patient portal. If you do not believe that our policy gives you the privacy and security protection you need, do not send e-mail or Internet communications to us. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org -- Dott. Andrea De Gasperi Direttore S.C. Anestesia e Rianimazione 2 Dipartimento Chirurgico Polispecialistico Segreteria Direttore: Tel. 02 6444.4617 Fax 6444.4891 Segreteria Degenza: Tel. 02 6444.2553 Fax 6444.2907 Mail personale [email protected] ASST Grande Ospedale Metropolitano Niguarda Ca' Granda Milano www.ospedaleniguarda.it Attenzione "Le informazioni contenute in questo messaggio e-mail sono destinate esclusivamente alla persone o entità cui è stato indirizzato e può contenere informazioni riservate. Ogni reinvio, diffusione o altro utilizzo o qualunque azione basata sul presente messaggio da parte di persone o entità diverse dal destinatario, se non espressamente autorizzate dal mittente, sono proibiti. Se avete ricevuto questo messaggio per errore, siete pregati di contattare immediatamente il mittente via e-mail e di cancellarlo da ogni vostro computer". Grazie. Disclaimer "The information transmitted in this e-mail message is intended only for the person or entity to which it is addressed and may contain confidential information. Any retransmission, dissemination or other use of, or taking of any action in reliance upon, this information by person or entity other than the intended recipient, if not clearly authorized by the sender, is prohibited. If you have received this communication in error, please notify the sender immediately by e-mail and delete the message from any computer". Thank you. Si avvisano i destinatari che questo messaggio e' aziendale e non ha natura personale. Le risposte a questo indirizzo mittente potranno essere conosciute, per motivi aziendali, da altre persone dell' ASST Grande Ospedale Metropolitano Niguarda autorizzate a tal fine dal Titolare
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
