Predicting sepsis at emergency department triage: Implementing clinical and laboratory markers within the first nursing assessment to enhance diagnostic accuracy

IF 2.4 3区医学 Q1 NURSING Journal of Nursing Scholarship Pub Date : 2024-06-17 DOI:10.1111/jnu.13002

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

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Abstract

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)

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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。

背景：在急诊科（ED）分诊过程中早期识别败血症既有价值又具有挑战性。许多研究都在努力确定临床和生化标准，以协助临床医生及时诊断脓毒症，但很少有研究评估这些标准在急诊科分诊环境中的有效性。本研究旨在探讨在分诊阶段评估的临床和实验室指标在识别脓毒症患者方面的准确性：在一家大型城市学术医院开展了一项前瞻性研究，根据临床和实验室指标实施旨在早期识别脓毒症患者的分诊方案。多学科专家小组对病例进行了审查，以确保准确识别脓毒症患者。分析的变量包括夏尔森合并症指数、平均动脉压（MAP）、二氧化碳分压（PetCO2）、白细胞计数、嗜酸性粒细胞计数、C反应蛋白与白蛋白比值、降钙素原和乳酸盐：共纳入 235 名患者。多变量分析确定了降钙素原≥1 ng/mL（OR 5.2；P 2 ≤ 28 mmHg（OR 2.7；P = 0.031）和 MAP 结论：我们的研究强调了降钙素原和平均动脉压的重要性，同时将 CRP/白蛋白比值和 PetCO2 作为在急诊室对疑似败血症患者进行初步评估时需要考虑的重要变量：在急诊科（ED）分诊过程中早期识别脓毒症具有挑战性。利用简单的临床和实验室指标实施急诊科分诊方案可识别脓毒症患者，并具有很好的鉴别力（AUC 0.88）。

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来源期刊

Journal of Nursing Scholarship 医学-护理

CiteScore

6.30

自引率

5.90%

发文量

审稿时长

6-12 weeks

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.