快速区分病毒和细菌来源的辅助生物芯片可提高因呼吸道疾病到急诊科(ED)就诊的肿瘤患者的护理质量

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
David Robinson MD , Carolyn Gardiner MD , Jacqueline Furbacher MD , Michael Vu MD , Dacia Ticas MD , Carrie Bakunas MD , Neomi Sepulveda BS , Joseph Boyle BSN , Benjamin Karfunkle MD
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引用次数: 0

摘要

背景肿瘤患者因急性呼吸道疾病(ARI)前往急诊室就诊时,由于潜在感染的风险和免疫力低下的状况,需要进行广泛的检查和早期治疗。由于确定非细菌感染源耗时较长,因此通常需要及早使用抗生素。一种新型宿主生物芯片可快速区分细菌和病毒来源,从而提高急诊室资源利用率,减少不必要的抗生素用量,提高医疗质量。MeMed BV® (BV) 是一种经 FDA 批准的快速免疫测定法,可报告三种宿主蛋白(TNF 相关凋亡诱导配体 (TRAIL)、γ 干扰素诱导蛋白 10 (IP-10) 和 C 反应蛋白 (CRP))的计算综合得分(0-100)。BV 评分和急诊室标准护理检测是通过修改后的急诊室败血症方案(mEDSP)获得的。65 分以上与细菌感染有关,而 10 分以下与病毒感染有关。入院患者的实验室、放射科、专业和设施费用(病房费、护理费和辅助费用)总和。调查人员接受了三项调查,目的是:(1)确定检测前的患病概率;(2)确定收到 BV 检测结果后的患病概率;(3)询问如果提前收到 BV 检测结果,可能会放弃或改变哪些资源。进一步检测证实没有细菌感染源。对 mEDSP 和入院情况进行的成本和资源评审显示,不必要的抗生素可能减少了 59%,实验室检测减少了 24.2%,总成本减少了 23.2%。入院时间可减少 24 小时(43%)。此外,急诊室医生也愿意根据该检测结果改变护理方式。结论通过在急诊室及早识别急性呼吸道感染的非细菌性病源,可以显著提高资源利用率和护理质量。如果在急诊室及早使用辅助生物标志物来区分病毒和其他来源,就能提高质量和资源利用率。有必要在急诊肿瘤学领域开展进一步的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An adjunct bio-array that rapidly differentiates viral from bacterial sources can improve quality of care in Oncology patients presenting to Emergency Departments (EDs) with respiratory illnesses

Background

Oncology patients presenting to EDs with acute respiratory illnesses (ARI) require a broad workup and early treatment due to risk of underlying infection and immunocompromised status. Early antibiotic administration is often required as determining a nonbacterial source is time consuming. A novel host bio-array developed to rapidly differentiate bacterial from viral sources could improve ED resource utilization, reduce unnecessary antibiotics, and increase healthcare quality.

Methods

An IRB approved subject on multiple immunosuppressants presents with ARI and positive SIRS criteria. The MeMed BV® (BV) is an FDA approved rapid immunoassay that reports a computationally integrated score (0-100) of three host proteins (TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), and C-reactive protein (CRP). The BV score and ED standard of care tests were obtained in a modified ED sepsis protocol (mEDSP). Scores above 65 are associated with bacterial infections, while scores below 10 are associated with viral infections. Cost of laboratory, radiology, professional and facilities fees (room charges, nursing, and ancillaries) were summed for the admission. Investigators received three surveys to: (1) establish pretest probability of disease, (2) determine posttest probability after receiving BV results, (3) query what resources might be withheld or changed if presented with the BV test results early.

Results

The BV reported a ‘0’ value (viral source) within 20 minutes. Further testing confirmed no bacterial source of infection. An adjudicated cost and resource review of the mEDSP and admission revealed a potential reduction of unnecessary antibiotics by 59%, lab testing by 24.2%, and overall costs by 23.2%. Admission time could have been reduced by 24 hours (43%). Furthermore, the ED physician was amenable to changing care based on this test.

Conclusion

Significant improvement in resource utilization and greater quality was identified with early identification of nonbacterial sources in ARI in the ED. Adjunct biomarkers differentiating viral from other sources can improve quality and resource utilization when deployed early in the ED. Further trials in the Emergency Oncology realm are necessary.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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