Althunayyan SM, Alsofayan YM, Khan AA. Shock index and modified shock index as triage screening tools for sepsis.
J Infect Public Health 2019;
12:822-826. [PMID:
31113741 DOI:
10.1016/j.jiph.2019.05.002]
[Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 05/05/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND
Fever is one of the common conditions encountered in the emergency department, which related to a spectrum of diseases severity. Identifying sepsis patients from uncomplicated febrile patients is challenging in the emergency triage areas and pre-hospital settings.
OBJECTIVES
Assess the triage shock index (SI) and modified shock index (MSI) in febrile patients as predictors for sepsis and sepsis-related outcomes.
DESIGN
A retrospective cohort study.
SETTING
Patients presented to the Emergency Department of King Khalid University Hospital.
PATIENTS AND METHODS
The analysis included all febrile adult patients triaged with a temperature of 38 °C or more from January 2016 to December 2017. Based on triage vital sign we calculate the SI with cut-off levels of ≥0.7 and ≥1 and MSI with cut-off levels of ≥1 and ≥1.3. We report the Relative Risk, Sensitivity, Specificity, Positive and Negative Predictive Values of the predictors.
MAIN OUTCOME MEASURES
Sepsis and sepsis-related outcomes such as hyperlactatemia, ICU admission, and 28 days mortality.
SAMPLE SIZE
274 patients.
RESULTS
274 patients met our inclusion/exclusion criteria. Of the 274 patients, 252 patient (92%) were septic, 62 patients (22%) had hyperlactatemia, 20 patients admitted to the ICU, and 5 patient died within 28 days. An MSI of ≥1 had a sensitivity of 90% for sepsis predication, 85% for ICU admission and 100% for 28 days mortality. MSI of ≥1.3 showed a specificity (59%-100%) for all the outcomes of interest. Non-significant statistical trends of greater accuracy of MSI over SI.
CONCLUSION
MSI and SI were found to be promising predictors in triaging febrile patients. However no single cut-off values of MSI or SI were found to have an optimal accuracy for prediction of sepsis and sepsis-related outcomes. Further studies are required to assess the incorporation of MSI in a multi-item scaling system for the prediction of sepsis and its related outcomes.
LIMITATIONS
Small single center study and the results may not be generalizable.
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