Ugo Giulio Sisto MD, Stefano Di Bella MD, Elisa Porta BSN, RN, Giorgia Franzoi BSN, RN, Franco Cominotto MD, Elena Guzzardi RN, Nicola Artusi MD, Caterina Anna Giudice MD, Eugenia Dal Bo MSN, RN, Nicholas Collot MD, Francesca Sirianni MD, Savino Russo MD, Gianfranco Sanson PhD, RN
{"title":"在急诊科分诊时预测败血症：在首次护理评估中采用临床和实验室指标，提高诊断准确性。","authors":"Ugo Giulio Sisto MD, Stefano Di Bella MD, Elisa Porta BSN, RN, Giorgia Franzoi BSN, RN, Franco Cominotto MD, Elena Guzzardi RN, Nicola Artusi MD, Caterina Anna Giudice MD, Eugenia Dal Bo MSN, RN, Nicholas Collot MD, Francesca Sirianni MD, Savino Russo MD, Gianfranco Sanson PhD, RN","doi":"10.1111/jnu.13002","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO<sub>2</sub>), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; <i>p</i> < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; <i>p</i> < 0.001); PetCO<sub>2</sub> ≤ 28 mmHg (OR 2.7; <i>p</i> = 0.031), and MAP <85 mmHg (OR 7.5; <i>p</i> < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO<sub>2</sub> as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.</p>\n </section>\n \n <section>\n \n <h3> Clinical Relevance</h3>\n \n <div>\n \n <ul>\n \n \n <li>Early identification of sepsis since the emergency department (ED) triage is challenging</li>\n \n \n <li>Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88)</li>\n </ul>\n </div>\n </section>\n </div>","PeriodicalId":51091,"journal":{"name":"Journal of Nursing Scholarship","volume":"56 6","pages":"757-766"},"PeriodicalIF":2.4000,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy\",\"authors\":\"Ugo Giulio Sisto MD, Stefano Di Bella MD, Elisa Porta BSN, RN, Giorgia Franzoi BSN, RN, Franco Cominotto MD, Elena Guzzardi RN, Nicola Artusi MD, Caterina Anna Giudice MD, Eugenia Dal Bo MSN, RN, Nicholas Collot MD, Francesca Sirianni MD, Savino Russo MD, Gianfranco Sanson PhD, RN\",\"doi\":\"10.1111/jnu.13002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO<sub>2</sub>), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; <i>p</i> < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; <i>p</i> < 0.001); PetCO<sub>2</sub> ≤ 28 mmHg (OR 2.7; <i>p</i> = 0.031), and MAP <85 mmHg (OR 7.5; <i>p</i> < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO<sub>2</sub> as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Clinical Relevance</h3>\\n \\n <div>\\n \\n <ul>\\n \\n \\n <li>Early identification of sepsis since the emergency department (ED) triage is challenging</li>\\n \\n \\n <li>Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88)</li>\\n </ul>\\n </div>\\n </section>\\n </div>\",\"PeriodicalId\":51091,\"journal\":{\"name\":\"Journal of Nursing Scholarship\",\"volume\":\"56 6\",\"pages\":\"757-766\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-06-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Nursing Scholarship\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jnu.13002\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nursing Scholarship","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jnu.13002","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy
Background
Early identification of sepsis in the emergency department (ED) triage is both valuable and challenging. Numerous studies have endeavored to pinpoint clinical and biochemical criteria to assist clinicians in the prompt diagnosis of sepsis, but few studies have assessed the efficacy of these criteria in the ED triage setting. The aim of the study was to explore the accuracy of clinical and laboratory markers evaluated at the triage level in identifying patients with sepsis.
Methods
A prospective study was conducted in a large academic urban hospital, implementing a triage protocol aimed at early identification of septic patients based on clinical and laboratory markers. A multidisciplinary panel of experts reviewed cases to ensure accurate identification of septic patients. Variables analyzed included: Charlson comorbidity index, mean arterial pressure (MAP), partial pressure of carbon dioxide (PetCO2), white cell count, eosinophil count, C-reactive protein to albumin ratio, procalcitonin, and lactate.
Results
A total of 235 patients were included. Multivariable analysis identified procalcitonin ≥1 ng/mL (OR 5.2; p < 0.001); CRP-to-albumin ratio ≥32 (OR 6.6; p < 0.001); PetCO2 ≤ 28 mmHg (OR 2.7; p = 0.031), and MAP <85 mmHg (OR 7.5; p < 0.001) as independent predictors for sepsis. MAP ≥85 mmHg, CRP/albumin ratio <32, and procalcitonin <1 ng/mL demonstrated negative predictive values for sepsis of 90%, 89%, and 88%, respectively.
Conclusions
Our study underscores the significance of procalcitonin and mean arterial pressure, while introducing CRP/albumin ratio and PetCO2 as important variables to consider in the very initial assessment of patients with suspected sepsis in the ED.
Clinical Relevance
Early identification of sepsis since the emergency department (ED) triage is challenging
Implementing the ED triage protocol with simple clinical and laboratory markers allows to recognize patients with sepsis with a very good discriminatory power (AUC 0.88)
期刊介绍：
This widely read and respected journal features peer-reviewed, thought-provoking articles representing research by some of the world’s leading nurse researchers.
Reaching health professionals, faculty and students in 103 countries, the Journal of Nursing Scholarship is focused on health of people throughout the world. It is the official journal of Sigma Theta Tau International and it reflects the society’s dedication to providing the tools necessary to improve nursing care around the world.
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