Search

La sepsis desencadena una reacción en cadena en el organismo debido a una infección produciendo una respuesta incontrolada que puede acabar en fallo multiorgánico y la muerte. Para facilitar los diagnósticos se han creado diferentes sistemas para detectar de forma temprana diferentes patologías, se trata de escalas conocidas como Early Warning Scores (EWS) o escalas de alerta temprana. El objetivo de este trabajo es conocer la eficacia diagnóstica de las EWS utilizadas en pacientes con sepsis en servicios de urgencias y emergencias con posibilidad de ingreso en UCI. Se realizó una revisión sistemática y metaanálisis. La base de datos utilizada fue PubMed, seleccionando finalmente 10 artículos. Debido a la gran variedad de escalas diagnósticas, nos centramos en qSOFA, NEWS/NEWS2 y SIRS, y como resultado el ingreso en UCI. Para realizar el me-taanálisis se utilizaron fórmulas matemáticas para obtener los datos reales de pacientes afectados. Se empleó el test de Deek para conocer la existencia de riesgo de sesgo de publicación. Para conocer la evidencia de la calidad de los artículos se utilizó la herramienta QUADAS-2. Un total de 344.724 pacientes fueron estudiados, de los cuales 33.502 fueron ingresos en UCI. La sensibilidad para qSOFA, NEWS/NEWS2 y SIRS fue de 0.31, 0.51 y 0.69 y la especificidad 0.92, 0.91 y 0.44 respectivamente. Presentaron un AUROC de qSOFA=0.73, NEWS/NEWS2=0.79 y SIRS=0.58, encontrando que NEWS/NEWS2 fue la que mejor resultados obtuvo. Las tres escalas analizadas muestran efectividad para el ingreso en UCI de pacientes con sepsis, obteniendo que NEWS/NEWS2 tuvo los mejores resultados a pesar de no ser una escala creada específicamente para la detección del paciente con sepsis., Grado en Enfermería

Bakgrund: Sepsis är ett tillstånd som årligen drabbar ca 50.000 personer i Sverige. Tillståndet har en hög dödlighet och de som överlever sepsis riskerar långtidskomplikationer efter tillfrisknande. Vanliga symtom vid sepsis är andfåddhet, kräkningar, smärta, feber, frossa och påverkat mental status. Dock kan sepsis vara svårt att identifiera då symtomen ibland är diffusa. Tidig behandling med antibiotika räddar liv. Screeningverktyg som används inom ambulanssjukvården i Region Halland för att identifiera sepsis är qSOFA (Quick Sequential Organ Failure Assessment) och SIRS (Systemic Inflammatory Response Syndrome). Syfte: Syftet med studien var att undersöka patientkarakteristiska, dödlighet och slutdiagnos hos patienter som triagerats med ESS 44/47 (misstänkt infektion) och ESS 53 (ospecifika symtom) av ambulanspersonal samt patienter som har en positiv qSOFA eller SIRS. Syftet var även att undersöka förekomsten av patienter där ambulanspersonal haft infektionsmisstanke (ESS 44/47) men inte förvarnat (orange, gul eller grön prioritet) in till sjukhus trots positiv qSOFA. Metod: Studien är en kvantitativ retrospektiv journalgranskningsstudie. Den inkluderade populationen var ambulansuppdrag inom Region Halland mellan 2019 och 2022 som triagerats med ESSkoderna 44, 47 och 53. 4860 ambulansuppdrag inkluderades i studien. Resultat: 63% i gruppen ESS 44/47 och 30% i ESS 53 fick en infektionsdiagnos på akutmottagningarna. Ur hela populationen lades 83% in på sjukhus och 15% avled inom 30 dagar. Högsta dödligheten identifierades bland qSOFA positiva (36%) vilket var signifikant högre än dödligheten bland de med positiv SIRS. Slutsats: Majoriteten av populationen läggs in på sjukhus, vilket speglar vårdbehovet. Dödligheten är hög vilket ställer höga krav på den prehospitala vården. Vid sepsis är tid till behandling det som räddar liv, något som prehospital sjukvårdspersonal kan vara med och påverka.

Bakgrund: Sepsis är ett tillstånd som årligen drabbar ca 50.000 personer i Sverige. Tillståndet har en hög dödlighet och de som överlever sepsis riskerar långtidskomplikationer efter tillfrisknande. Vanliga symtom vid sepsis är andfåddhet, kräkningar, smärta, feber, frossa och påverkat mental status. Dock kan sepsis vara svårt att identifiera då symtomen ibland är diffusa. Tidig behandling med antibiotika räddar liv. Screeningverktyg som används inom ambulanssjukvården i Region Halland för att identifiera sepsis är qSOFA (Quick Sequential Organ Failure Assessment) och SIRS (Systemic Inflammatory Response Syndrome). Syfte: Syftet med studien var att undersöka patientkarakteristiska, dödlighet och slutdiagnos hos patienter som triagerats med ESS 44/47 (misstänkt infektion) och ESS 53 (ospecifika symtom) av ambulanspersonal samt patienter som har en positiv qSOFA eller SIRS. Syftet var även att undersöka förekomsten av patienter där ambulanspersonal haft infektionsmisstanke (ESS 44/47) men inte förvarnat (orange, gul eller grön prioritet) in till sjukhus trots positiv qSOFA. Metod: Studien är en kvantitativ retrospektiv journalgranskningsstudie. Den inkluderade populationen var ambulansuppdrag inom Region Halland mellan 2019 och 2022 som triagerats med ESSkoderna 44, 47 och 53. 4860 ambulansuppdrag inkluderades i studien. Resultat: 63% i gruppen ESS 44/47 och 30% i ESS 53 fick en infektionsdiagnos på akutmottagningarna. Ur hela populationen lades 83% in på sjukhus och 15% avled inom 30 dagar. Högsta dödligheten identifierades bland qSOFA positiva (36%) vilket var signifikant högre än dödligheten bland de med positiv SIRS. Slutsats: Majoriteten av populationen läggs in på sjukhus, vilket speglar vårdbehovet. Dödligheten är hög vilket ställer höga krav på den prehospitala vården. Vid sepsis är tid till behandling det som räddar liv, något som prehospital sjukvårdspersonal kan vara med och påverka.

Sepsis is a set of clinical manifestations caused by the presence of an infectious etiological agent. Septic shock is characterized by being an infectious-type syndrome where there is multi-organ failure and patient mortality increases if the condition is not managed promptly. A bibliographic compilation is carried out where the objective was to determine the benefits of the implementation of the sepsis code in health homes in patients who come to the consultation with clinical characteristics of sepsis or septic shock. The type of research was descriptive, non-experimental and bibliographic review. The review concluded that the implementation of the sepsis code in a health home could promptly diagnose sepsis or septic shock and that its use decreased patient mortality. In addition, one author mentions that elevated lactate and creatinine levels, together with the administration of amines increase the incidence of mortality in patients with sepsis and septic shock., La sepsis es un conjunto de manifestaciones clínicas causadas por la presencia de un agente etiológico infeccioso, el shock séptico se caracteriza por ser un síndrome de tipo infeccioso donde existe una falla multiorgánica y aumenta la mortalidad del paciente si no se maneja el cuadro oportunamente. Se realiza una recopilación bibliográfica en donde como objetivo se pretendía determinar los beneficios de la implementación del código sepsis en casas de salud en pacientes que llegan a consulta con características clínicas de sepsis o shock séptico. El tipo de investigación fue de características descriptivas, no experimental y revisión bibliográfica. La revisión tuvo como conclusión que la implementación del código sepsis en una casa de salud podía diagnosticar oportunamente sepsis o shock séptico y que su utilización disminuía la mortalidad del paciente, además un autor menciona que los niveles de lactato y creatinina elevados, junto a administración de aminas aumentan la incidencia en mortalidad de los pacientes con sepsis y shock séptico.

Introduction: Sepsis has a mortality rate of 10-40% worldwide. Many screening tools for sepsis prediction and for emergency department (ED) triage are controversial. This study compared the accuracy of the scores for predicting 28-day mortality in adult patients with sepsis in the triage area of the ED. Methods: Adult patients who presented to the ED of a tertiary-care university hospital from January–December 2019 with an initial diagnosis of sepsis or other infection-related conditions were enrolled. We calculated predictive scores using information collected in the ED triage area. Prognostic accuracy was measured by the area under the receiver operating characteristic curve (AUROC) for predicting 28-day mortality as a primary outcome. The secondary outcomes included mechanical ventilation usage and vasopressor usage for 28 days. Results: We analyzed a total of 550 patients. The 28-day mortality rate was 12.4% (n = 68). The 28-day mortality rate was best detected by the National Early Warning Score (NEWS) (AUROC = 0.770; 95% confidence interval [CI]: 0.705-0.835), followed by the quick Sequential Organ Failure Assessment (qSOFA) score (AUROC = 0.7473; 95% CI: 0.688-0.806), Search Out Severity (SOS) score (AUROC = 0.749; 95% CI: 0.685-0.815), Emergency Severity Index (ESI) triage (AUROC = 0.599; 95% CI: 0.542-0.656, and the Systemic Inflammatory Response System (SIRS) criteria (AUROC = 0.588; 95% CI: 0.522-0.654]). The NEWS also provided a higher AUROC and outperformed for 28-day mechanical ventilator usage and 28-day vasopressor usage. Conclusion: The NEWS outperforms qSOFA, SOS, SIRS, and ESI triage in predicting 28-day mortality, mechanical ventilator, and vasopressor usage of a patient with sepsis who is seen at ED triage.&nbsp

Introduction: Sepsis has a mortality rate of 10-40% worldwide. Many screening tools for sepsis prediction and for emergency department (ED) triage are controversial. This study compared the accuracy of the scores for predicting 28-day mortality in adult patients with sepsis in the triage area of the ED. Methods: Adult patients who presented to the ED of a tertiary-care university hospital from January–December 2019 with an initial diagnosis of sepsis or other infection-related conditions were enrolled. We calculated predictive scores using information collected in the ED triage area. Prognostic accuracy was measured by the area under the receiver operating characteristic curve (AUROC) for predicting 28-day mortality as a primary outcome. The secondary outcomes included mechanical ventilation usage and vasopressor usage for 28 days. Results: We analyzed a total of 550 patients. The 28-day mortality rate was 12.4% (n = 68). The 28-day mortality rate was best detected by the National Early Warning Score (NEWS) (AUROC = 0.770; 95% confidence interval [CI]: 0.705-0.835), followed by the quick Sequential Organ Failure Assessment (qSOFA) score (AUROC = 0.7473; 95% CI: 0.688-0.806), Search Out Severity (SOS) score (AUROC = 0.749; 95% CI: 0.685-0.815), Emergency Severity Index (ESI) triage (AUROC = 0.599; 95% CI: 0.542-0.656, and the Systemic Inflammatory Response System (SIRS) criteria (AUROC = 0.588; 95% CI: 0.522-0.654]). The NEWS also provided a higher AUROC and outperformed for 28-day mechanical ventilator usage and 28-day vasopressor usage. Conclusion: The NEWS outperforms qSOFA, SOS, SIRS, and ESI triage in predicting 28-day mortality, mechanical ventilator, and vasopressor usage of a patient with sepsis who is seen at ED triage.&nbsp

Purpose: This Doctor of Nursing Practice (DNP) project aims to increase early recognition of patients with sepsis or septic shock by implementing a nurse-driven clinical decision support tool in the Northern Cochise Community Hospital (NCCH) emergency department (ED). In addition, a secondary purpose of this project was to consolidate descriptive information about local patient population diagnosed with sepsis, to give NCCH a better understanding of the scope of problem. Background: Sepsis is a clinical syndrome caused by an infection that becomes dysregulated host response resulting in organ dysfunction (The Society of Critical Care Medicine [SCCM], 2017, 2021). The Centers for Disease Control and Prevention (CDC) data indicates that approximately 1.7 million adults in America develop sepsis each year. Nearly 270,000 die from it, which is approximately 1 in 3 patients. Health care expenditures related to sepsis totaled $23.7 billion in 2013 (CDC, 2016, 2019). Methods: The method that guided this DNP project was FOCUS - Plan-Do-Check-Act (PDCA) four-cycle model to problem-solve for early sepsis recognition. The FOCUS process helped the sepsis team to identify root causes by analyzing acts from a retrospective chart review, pre-intervention. PDSA cycle allowed for a rapid assessment for changes and/or adjustments as needed, post-intervention. Results: In total, a pre-intervention retrospective charts review was conducted, yielding 1,648 charts. After exclusions, a total of 32 patients’ charts in 2020 and 45 charts in 2021 were used for this quality improvement (QI) project. These charts met SIRS/Sepsis criteria with and suspected infection(s) that missed a sepsis diagnosis. Unfortunately, many charts lacked follow-up vital signs, and providers did not complete full work-up for a more accurate inclusion count. Conclusions: QI project purpose was to increase early sepsis recognition at NCCH ED using nurse-driven CDST, and to consolidate descriptive information about lo

Purpose: There are conflicting data regarding the role of the National Early Warning Score 2 (NEWS2) in predicting adverse outcomes in patients with infectious diseases. New-onset atrial fibrillation (NO-AF) has been suggested as a sepsis-defining sign of organ dysfunction. This study aimed to examine the prognostic accuracy of NEWS2 and whether NO-AF can provide prognostic information in emergency department (ED) patients with suspected bacterial infections. Patients and Methods: Secondary analyses of data from a prospective observational cohort study of adults admitted in a 6-month period with suspected bacterial infections. We used the composite endpoint of in-hospital mortality or transfer to the intensive care unit as the primary outcome. The prognostic accuracy of NEWS2 and quick sequential organ failure assessment (qSOFA) and covariate-adjusted area under the receiver operating curves (AAUROC) were used to describe the performance of the scores. Logistic regression analysis was used to examine the association between NO-AF and the composite endpoint. Results: A total of 2055 patients were included in this study. The composite endpoint was achieved in 198 (9.6%) patients. NO-AF was observed in 80 (3.9%) patients. The sensitivity and specificity for NEWS2 ≥5 were 70.2% (63.3–76.5) and 60.2% (57.9–62.4), respectively, and those for qSOFA ≥2 were 26.3% (20.3–33.0) and 91.0% (89.6–92.3), respectively. AAUROC for NEWS2 and qSOFA were 0.68 (0.65–0.73) and 0.63 (0.59–0.68), respectively. The adjusted odds ratio for achieving the composite endpoint in 48 patients with NO-AF who fulfilled the NEWS2 ≥5 criteria was 2.71 (1.35–5.44). Conclusion: NEWS2 had higher sensitivity but lower specificity and better, albeit poor, discriminative ability to predict the composite endpoint compared to qSOFA. NO-AF can provide important prognostic information.

Purpose: There are conflicting data regarding the role of the National Early Warning Score 2 (NEWS2) in predicting adverse outcomes in patients with infectious diseases. New-onset atrial fibrillation (NO-AF) has been suggested as a sepsis-defining sign of organ dysfunction. This study aimed to examine the prognostic accuracy of NEWS2 and whether NO-AF can provide prognostic information in emergency department (ED) patients with suspected bacterial infections. Patients and Methods: Secondary analyses of data from a prospective observational cohort study of adults admitted in a 6-month period with suspected bacterial infections. We used the composite endpoint of in-hospital mortality or transfer to the intensive care unit as the primary outcome. The prognostic accuracy of NEWS2 and quick sequential organ failure assessment (qSOFA) and covariate-adjusted area under the receiver operating curves (AAUROC) were used to describe the performance of the scores. Logistic regression analysis was used to examine the association between NO-AF and the composite endpoint. Results: A total of 2055 patients were included in this study. The composite endpoint was achieved in 198 (9.6%) patients. NO-AF was observed in 80 (3.9%) patients. The sensitivity and specificity for NEWS2 ≥5 were 70.2% (63.3–76.5) and 60.2% (57.9–62.4), respectively, and those for qSOFA ≥2 were 26.3% (20.3–33.0) and 91.0% (89.6–92.3), respectively. AAUROC for NEWS2 and qSOFA were 0.68 (0.65–0.73) and 0.63 (0.59–0.68), respectively. The adjusted odds ratio for achieving the composite endpoint in 48 patients with NO-AF who fulfilled the NEWS2 ≥5 criteria was 2.71 (1.35–5.44). Conclusion: NEWS2 had higher sensitivity but lower specificity and better, albeit poor, discriminative ability to predict the composite endpoint compared to qSOFA. NO-AF can provide important prognostic information.

Pediatric sepsis continues to be one of the main causes of mortality in low and middle-income countries, its early recognition in emergencies requires the use of criteria that allow us to predict the severity of the patient. Objective : our study aims to compare the SIRS criteria and qSOFA regarding its discriminatory capacity in mortality in children with sepsis. Methods: a prospective multicenter study was carried out in emergency services enrolling children with suspected sepsis subsequently admitted to the PICU, in which the scores in qSOFA and SIRS were evaluated comparing them with the results at hospital discharge. Results: 64 patients were enrolled, admitted in emergency in Sepsis (19%), Septic Shock (20.6%) and with Multiple Organ Dysfunction (60.4%) stage, with a mortality respectively of 9.5% and 14.3% and 76.2%; germ could be rescued in 33.9% of the cases; Evaluating the SIRS criteria, we see that the absence of them is associated with lower mortality (p = 0.044; OR 0.618: 95% CI 0.502-0.761); otherwise, 2 or more qSOFA criteria are associated with higher mortality (p = 0.047 ; OR 3.52: 95% CI 1.090-11.371). Conclusion: both criteria used to define sepsis in pediatrics demonstrated their usefulness, the use of the qSOFA score given its close relationship with mortality can be used to anticipate life-threatening organ alterations., La sepsis pediátrica continúa siendo una causa importante de mortalidad en países de bajos y medianos ingresos, su reconocimiento temprano en emergencias requiere del uso de criterios que nos permitan predecir anticipadamente la gravedad del paciente. Objetivo: nuestro estudio pretende comparar los criterios de SIRS y qSOFA en cuanto a su capacidad discriminatoria en mortalidad en sepsis pediátrica. Métodos: realizamos un estudio multicéntrico, prospectivo en servicios de emergencias incluyendo niños con sospecha de sepsis subsecuentemente ingresados a UTIP, en los cuales se evaluaron los puntajes en SIRS y qSOFA comparándolos con los resultados al egreso. Resultados: se enrolaron 64 pacientes, admitidos en estadios de Sepsis (19%), Shock Séptico (20,6%) y con Disfunción Multiorgánica (60,4%), con una mortalidad respectivamente de 9,5%, 14,3% y 76,2%; en 33,9% de los casos se pudo rescatar algún germen. Evaluando los criterios SIRS vemos que la ausencia de ellos se asocia con mayor sobrevivencia (p=0,044; OR 0,618: IC95% 0,502-0,761), Por otro lado, 2 o más criterios qSOFA se asocia con mayor mortalidad (p=0,047; OR 3,52: IC95% 1,090-11,371). Conclusión: ambos criterios utilizados para definir sepsis en pediatría demostraron su utilidad, el uso del score qSOFA dada a su estrecha relación con la mortalidad puede emplearse para anticipar alteraciones orgánicas potencialmente mortales.

Background and Objectives: Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. Materials and Methods. This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall inhospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. Results. The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; p = 0.046). In the qSOFA > 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. Conclusions. Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival.

Este Trabajo de Fin de Grado (TFG) tiene como objetivo la realización de una aplicación para móviles Android que permita el cálculo de la escala qSOFA para que se emplee en pacientes que se encuentren en una emergencia médica. Para ello, primero se ha realizado un estudio sobre la evolución de la sepsis a lo largo de los últimos años. De este modo, se establece un marco teórico que ayuda a entender el problema que genera la sepsis en los pacientes y qué técnicas se utilizan para diagnosticarla y tratarla de manera correcta. Para poder caracterizar la sepsis se han ido realizando diferentes escalas que ayudan a detectar problemas en los pacientes, por ello también se ha realizado un estado del arte de las distintas escalas utilizadas para ello. Se ha estudiado la evolución de las escalas y su integración en el diagnóstico de sepsis, siendo las escalas SOFA y qSOFA las utilizadas actualmente para ello. Una vez establecido el marco teórico, se explica la aplicación desarrollada para calcular la escala qSOFA, para que no quede ninguna duda de su uso práctico. Además se incluye un análisis comparativo de una muestra de pacientes centrada en las escalas SOFA y qSOFA, viendo de este modo que beneficios puede tener el uso de la aplicación en pacientes sospechosos de sepsis., The objective of this project is to design an app for Android devices that allows the calculation of the qSOFA score to be used in patients who are in a medical emergency. To archive this, a study was first developed about the evolution of sepsis over the last few years. In this way, a theoretical framework about sepsis is established and it would help to understand the problem that sepsis generates in patients and what techniques are used to diagnose and treat it correctly. In order to characterize sepsis, different scales have been made to help detect problems in patients, which is why a state of the art of the different scales used for this has also been made. The evolution of the scales and their integration in the diagnosis of sepsis has also been studied, being the SOFA and qSOFA scales currently used for this. Once the theoretical framework is established, the application developed to calculate the qSOFA scale is explained, so that there is no doubt about its practical use. In addition, a comparative analysis of a sample of patients focused on the SOFA and qSOFA scales is included, thus seeing what benefits the use of the application may have in patients suspected of sepsis., Grado en Ingeniería de Tecnologías de Telecomunicación

Este Trabajo de Fin de Grado (TFG) tiene como objetivo la realización de una aplicación para móviles Android que permita el cálculo de la escala qSOFA para que se emplee en pacientes que se encuentren en una emergencia médica. Para ello, primero se ha realizado un estudio sobre la evolución de la sepsis a lo largo de los últimos años. De este modo, se establece un marco teórico que ayuda a entender el problema que genera la sepsis en los pacientes y qué técnicas se utilizan para diagnosticarla y tratarla de manera correcta. Para poder caracterizar la sepsis se han ido realizando diferentes escalas que ayudan a detectar problemas en los pacientes, por ello también se ha realizado un estado del arte de las distintas escalas utilizadas para ello. Se ha estudiado la evolución de las escalas y su integración en el diagnóstico de sepsis, siendo las escalas SOFA y qSOFA las utilizadas actualmente para ello. Una vez establecido el marco teórico, se explica la aplicación desarrollada para calcular la escala qSOFA, para que no quede ninguna duda de su uso práctico. Además se incluye un análisis comparativo de una muestra de pacientes centrada en las escalas SOFA y qSOFA, viendo de este modo que beneficios puede tener el uso de la aplicación en pacientes sospechosos de sepsis., The objective of this project is to design an app for Android devices that allows the calculation of the qSOFA score to be used in patients who are in a medical emergency. To archive this, a study was first developed about the evolution of sepsis over the last few years. In this way, a theoretical framework about sepsis is established and it would help to understand the problem that sepsis generates in patients and what techniques are used to diagnose and treat it correctly. In order to characterize sepsis, different scales have been made to help detect problems in patients, which is why a state of the art of the different scales used for this has also been made. The evolution of the scales and their integration in the diagnosis of sepsis has also been studied, being the SOFA and qSOFA scales currently used for this. Once the theoretical framework is established, the application developed to calculate the qSOFA scale is explained, so that there is no doubt about its practical use. In addition, a comparative analysis of a sample of patients focused on the SOFA and qSOFA scales is included, thus seeing what benefits the use of the application may have in patients suspected of sepsis., Grado en Ingeniería de Tecnologías de Telecomunicación

Este Trabajo de Fin de Grado (TFG) tiene como objetivo la realización de una aplicación para móviles Android que permita el cálculo de la escala qSOFA para que se emplee en pacientes que se encuentren en una emergencia médica. Para ello, primero se ha realizado un estudio sobre la evolución de la sepsis a lo largo de los últimos años. De este modo, se establece un marco teórico que ayuda a entender el problema que genera la sepsis en los pacientes y qué técnicas se utilizan para diagnosticarla y tratarla de manera correcta. Para poder caracterizar la sepsis se han ido realizando diferentes escalas que ayudan a detectar problemas en los pacientes, por ello también se ha realizado un estado del arte de las distintas escalas utilizadas para ello. Se ha estudiado la evolución de las escalas y su integración en el diagnóstico de sepsis, siendo las escalas SOFA y qSOFA las utilizadas actualmente para ello. Una vez establecido el marco teórico, se explica la aplicación desarrollada para calcular la escala qSOFA, para que no quede ninguna duda de su uso práctico. Además se incluye un análisis comparativo de una muestra de pacientes centrada en las escalas SOFA y qSOFA, viendo de este modo que beneficios puede tener el uso de la aplicación en pacientes sospechosos de sepsis., The objective of this project is to design an app for Android devices that allows the calculation of the qSOFA score to be used in patients who are in a medical emergency. To archive this, a study was first developed about the evolution of sepsis over the last few years. In this way, a theoretical framework about sepsis is established and it would help to understand the problem that sepsis generates in patients and what techniques are used to diagnose and treat it correctly. In order to characterize sepsis, different scales have been made to help detect problems in patients, which is why a state of the art of the different scales used for this has also been made. The evolution of the scales and their integration in the diagnosis of sepsis has also been studied, being the SOFA and qSOFA scales currently used for this. Once the theoretical framework is established, the application developed to calculate the qSOFA scale is explained, so that there is no doubt about its practical use. In addition, a comparative analysis of a sample of patients focused on the SOFA and qSOFA scales is included, thus seeing what benefits the use of the application may have in patients suspected of sepsis., Grado en Ingeniería de Tecnologías de Telecomunicación

Este Trabajo de Fin de Grado (TFG) tiene como objetivo la realización de una aplicación para móviles Android que permita el cálculo de la escala qSOFA para que se emplee en pacientes que se encuentren en una emergencia médica. Para ello, primero se ha realizado un estudio sobre la evolución de la sepsis a lo largo de los últimos años. De este modo, se establece un marco teórico que ayuda a entender el problema que genera la sepsis en los pacientes y qué técnicas se utilizan para diagnosticarla y tratarla de manera correcta. Para poder caracterizar la sepsis se han ido realizando diferentes escalas que ayudan a detectar problemas en los pacientes, por ello también se ha realizado un estado del arte de las distintas escalas utilizadas para ello. Se ha estudiado la evolución de las escalas y su integración en el diagnóstico de sepsis, siendo las escalas SOFA y qSOFA las utilizadas actualmente para ello. Una vez establecido el marco teórico, se explica la aplicación desarrollada para calcular la escala qSOFA, para que no quede ninguna duda de su uso práctico. Además se incluye un análisis comparativo de una muestra de pacientes centrada en las escalas SOFA y qSOFA, viendo de este modo que beneficios puede tener el uso de la aplicación en pacientes sospechosos de sepsis., The objective of this project is to design an app for Android devices that allows the calculation of the qSOFA score to be used in patients who are in a medical emergency. To archive this, a study was first developed about the evolution of sepsis over the last few years. In this way, a theoretical framework about sepsis is established and it would help to understand the problem that sepsis generates in patients and what techniques are used to diagnose and treat it correctly. In order to characterize sepsis, different scales have been made to help detect problems in patients, which is why a state of the art of the different scales used for this has also been made. The evolution of the scales and their integration in the diagnosis of sepsis has also been studied, being the SOFA and qSOFA scales currently used for this. Once the theoretical framework is established, the application developed to calculate the qSOFA scale is explained, so that there is no doubt about its practical use. In addition, a comparative analysis of a sample of patients focused on the SOFA and qSOFA scales is included, thus seeing what benefits the use of the application may have in patients suspected of sepsis., Grado en Ingeniería de Tecnologías de Telecomunicación

Aims: To identify the most accurate early warning score (EWS) for predicting an adverse outcome in COVID-19 patients admitted to the emergency department (ED). Methods: In adult consecutive patients admitted (March 1-April 15, 2020) to the ED of a major referral centre for COVID-19, we retrospectively calculated NEWS, NEWS2, NEWS-C, MEWS, qSOFA, and REMS from physiological variables measured on arrival. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and the area under the receiver operating characteristic (AUROC) curve of each EWS for predicting admission to the intensive care unit (ICU) and death at 48 h and 7 days were calculated. Results: We included 334 patients (119 [35.6%] females, median age 66 [54-78] years). At 7 days, the rates of ICU admission and death were 56/334 (17%) and 26/334 (7.8%), respectively. NEWS was the most accurate predictor of ICU admission within 7 days (AUROC 0.783 [95% CI, 0.735-0.826]; sensitivity 71.4 [57.8-82.7]%; NPV 93.1 [89.8-95.3]%), while REMS was the most accurate predictor of death within 7 days (AUROC 0.823 [0.778–0.863]; sensitivity 96.1 [80.4-99.9]%; NPV 99.4[96.2–99.9]%). Similar results were observed for ICU admission and death at 48 h. NEWS and REMS were as accurate as the triage system used in our ED. MEWS and qSOFA had the lowest overall accuracy for both outcomes. Conclusion: In our single-centre cohort of COVID-19 patients, NEWS and REMS measured on ED arrival were the most sensitive predictors of 7-day ICU admission or death. EWS could be useful to identify patients with low risk of clinical deterioration.

The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.

Background: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB65) to fulfil this unmet clinical need. Methods: An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days. Results: One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/ L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised by a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g. SOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0–207.6], 23.4 [11.1–49.3] and 32.6 [9.4–113.6], respectively) and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations (< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MRproADM cut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities. Conclusions: In patients presenting to the ED with a suspect

The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.

N/A

Introduction: Early identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO2) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients. Methods: We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis. Results: By comparison of receiver operator characteristic curves, ETCO2 had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA. Conclusion: Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO2 performing slightly better as an outcome predictor.

Introduction: Early identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO2) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients. Methods: We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO2 ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis. Results: By comparison of receiver operator characteristic curves, ETCO2 had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA. Conclusion: Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO2 performing slightly better as an outcome predictor.

Background A proposed revision of sepsis definitions has abandoned the systemic inflammatory response syndrome (SIRS), defined organ dysfunction as an increase in total Sequential Organ Function Assessment (SOFA) score of ≥ 2, and conceived “qSOFA” (quick SOFA) as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare the diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in ED patients with infection. Methods Consecutive ED patients admitted with presumed infection were prospectively enrolled over 3 years. Sufficient observational data were collected to calculate SIRS, qSOFA, SOFA, comorbidity, and mortality. Results We enrolled 8,871 patients, with SIRS present in 4,176 (47.1%). SIRS was associated with increased risk of organ dysfunction (relative risk [RR] 3.5) and mortality in patients without organ dysfunction (OR 3.2). SIRS and qSOFA showed similar discrimination for organ dysfunction (area under the receiver operating characteristic curve, 0.72 vs 0.73). qSOFA was specific but poorly sensitive for organ dysfunction (96.1% and 29.7%, respectively). Mortality for patients with organ dysfunction was similar for Sepsis-2 and Sepsis-3 (12.5% and 11.4%, respectively), although 29% of patients with Sepsis-3 organ dysfunction did not meet Sepsis-2 criteria. Increasing numbers of Sepsis-2 organ system dysfunctions were associated with greater mortality. Conclusions SIRS was associated with organ dysfunction and mortality, and abandoning the concept appears premature. A qSOFA score ≥ 2 showed high specificity, but poor sensitivity may limit utility as a bedside screening method. Although mortality for organ dysfunction was comparable between Sepsis-2 and Sepsis-3, more prognostic and clinical information is conveyed using Sepsis-2 regarding numbe

Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists’ increased adherence to guidelines and “bundles”. The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment.Key Messages Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease. At least half of patients affected by sepsis are admitted to Internal Medicine wards. Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization.