TRAUMA YELLOW
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map

Meet the New Sepsis (same as the old sepsis)

7/20/2016

0 Comments

 
Picture
Picture
SIRS (>2) (old)

T <36 or >38
HR >90
RR >20
​WBC <4000 or >12000

​

Picture
qSOFA (>2) (new)

RR > 22
​AMS
​SBP <100mmHG

Septic shock (new):
  • need pressor to maintain MAP >65
  • lactate >2 after  resuscitation (original lactate not taken into account)
  • (prognostic BUT does not change management)
Picture
Full SOFA score:
​
Picture
History of Sepsis:
  • ​1980/90's: Sepsis definitions in medical literature
  • 2001/2002: Sepsis 2 and Barcelona Declaration
  • Multi-specialty (including EM) collaborative called Surviving Sepsis
  • 2013: Surviving Sepsis Campaign Bundles become mandages measures
  • 2016: Sepsis 3.0
    • 3 papers
      • consensus definitions
      • assessment of sepsis criteria
      • assessment of septic shock
Where did SOFA/qSOFA come from?
  • retrospective review of 1.3 million EHR records from a single us region over 2 years
  • confirmatory analysis using retrospective 700,000 national and international EHR records over 5 years (including pre-hospital, ED, wards, ICU data
  • suspected infection:
    • abx -> culture within 24 hrs OR
    • culture -> abx within 72 hrs

Area under the curve (1 is a perfect correlation, 0.5 is as good as random):
  • SIRS: 0.76 (0.75-0.77)
  • SOFA: 0.79 (0.78-0.80)
  • qSOFA: 0.82 (0.80-0.82)

Lactate:
  • not an independent predictor of primary or secondary outcome
  • trends point to qSOFA(1) + lactate (>2) = qSOFA (2)

New clinical Criteria for Septic Shock
  • systematic review and meta-analysis of 44 studies (n=166479)
  • expert consensus (Delphi process) to determine factors to analyze based on
  • cohort studies to test variables identified

EM not involved in new guidelines
  • declined to endorse new definitions after completed
  • editorials in AEM and other EM lit point out that:
    • No CMS acceptance for quality measure changes
    • No ICD-10 changes
    • Minimal change in practice for EM other than qSOFA rather than SIRS

Recent EM Literature Using New Definitions
  • qSOFA is ~80% sensitive (and a little better than CRB-65, so could use instead)

Take Away Points
  • qSOFA appropriate as a screening tool and useful as adjunct to baseline risk for risk stratification for sepsis (GCS, RR, SBP)
  • lactate further helps with risk stratification, but not an independent predictor of mortality or disposition
  • sepsis is a quality measure
0 Comments



Leave a Reply.

    Categories

     

    All
    Abx
    Article
    Cardiac
    EKG
    EKG Challenge
    GI Bleed
    Grand Rounds
    Headache
    ICU
    Orthopedic
    Pain
    Peds
    Reading
    Stroke
    Subarachnoid Hemorrhage
    Syncope
    Teaching Pearl
    Trauma
    Travel
    Zika

    Archive

     

    February 2018
    January 2018
    December 2017
    November 2017
    October 2017
    September 2017
    August 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    January 2016
    December 2015
    November 2015

    Picture
    Please read our Terms of Use.
Donate
This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

​Please refer to our Terms of Use. 
  • Clinical
    • Discharge Macros
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
    • Clinical Links
    • StatMacros
    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map