Derivation of a screen to identify severe sepsis and septic shock in the ED-BOMBARD vs. SIRS and qSOFA
| Autor: | Steven G. Rothrock, David D. Cassidy, Drew Bienvenu, Erich Heine, Brian Guetschow, Joshua G. Briscoe, Sean F. Isaak, Kenneth Chang, Mikaela Devaux, Riana Kahlon, Robert Lenoci, Amna Imran, Pichael Povlow, Sagar Patel |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Organ Dysfunction Scores Logistic regression 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Sepsis Internal medicine medicine Humans Derivation Severe sepsis Aged Retrospective Studies Aged 80 and over business.industry Septic shock Case-control study 030208 emergency & critical care medicine Retrospective cohort study General Medicine Middle Aged medicine.disease Shock Septic Case-Control Studies Predictive value of tests Shock (circulatory) Emergency Medicine Female medicine.symptom Emergency Service Hospital business |
| Zdroj: | The American Journal of Emergency Medicine. 37:1260-1267 |
| ISSN: | 0735-6757 |
| Popis: | To predict severe sepsis/septic shock in ED patients.We conducted a retrospective case-control study of patients ≥18 admitted to two urban hospitals with a combined ED census of 162,000. Study cases included patients with severe sepsis/septic shock admitted via the ED. Controls comprised admissions without severe sepsis/septic shock. Using multivariate logistic regression, a prediction rule was constructed. The model's AUROC was internally validated using 1000 bootstrap samples.143 study and 286 control patients were evaluated. Features predictive of severe sepsis/septic shock included: SBP ≤ 110 mm Hg, shock index/SI ≥ 0.86, abnormal mental status or GCS 15, respirations ≥ 22, temperature ≥ 38C, assisted living facility residency, disabled immunity. Two points were assigned to SI and temperature with other features assigned one point (mnemonic: BOMBARD). BOMBARD was superior to SIRS criteria (AUROC 0.860 vs. 0.798, 0.062 difference, 95% CI 0.022-0.102) and qSOFA scores (0.860 vs. 0.742, 0.118 difference, 95% CI 0.081-0.155) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was more sensitive than SIRS ≥ 2 (74.8% vs. 49%, 25.9% difference, 95% CI 18.7-33.1) and qSOFA ≥ 2 (74.8% vs. 33.6%, 41.2% difference, 95% CI 33.2-49.3) at predicting severe sepsis/septic shock. A BOMBARD score ≥ 3 was superior to SIRS ≥ 2 (76% vs. 45%, 32% difference, 95% CI 10-50) and qSOFA ≥ 2 (76% vs. 29%, 47% difference, 95% CI 25-63) at predicting sepsis mortality.BOMBARD was more accurate than SIRS and qSOFA at predicting severe sepsis/septic shock and sepsis mortality. |
| Databáze: | OpenAIRE |
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