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|a Filbin, Michael R.
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|a Massachusetts Institute of Technology. Center for Biomedical Engineering
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|a Massachusetts Institute of Technology. Department of Electrical Engineering and Computer Science
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|a Thorsen, Jill E.
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|a Lynch III, James Charles
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|a Gillingham, Trent D.
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|a Pasakarnis, Corey L.
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|a Capp, Roberta
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|a Shapiro, Nathan I.
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|a Mooncai, Theodore
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|a Hou, Peter C.
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|a Heldt, Thomas
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|a Reisner, Andrew T.
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|a Challenges and Opportunities for Emergency Department Sepsis Screening at Triage
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|b Springer Science and Business Media LLC,
|c 2020-12-22T16:47:29Z.
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|z Get fulltext
|u https://hdl.handle.net/1721.1/128894
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|a Feasibility of ED triage sepsis screening, before diagnostic testing has been performed, has not been established. In a retrospective, outcome-blinded chart review of a one-year cohort of ED adult septic shock patients ("derivation cohort") and three additional, non-consecutive months of all adult ED visits ("validation cohort"), we evaluated the qSOFA score, the Shock Precautions on Triage (SPoT) vital-signs criterion, and a triage concern-for-infection (tCFI) criterion based on risk factors and symptoms, to screen for sepsis. There were 19,670 ED patients in the validation cohort; 50 developed ED septic shock, of whom 60% presented without triage hypotension, and 56% presented with non-specific symptoms. The tCFI criterion improved specificity without substantial reduction of sensitivity. At triage, sepsis screens (positive qSOFA vital-signs and tCFI, or positive SPoT vital-signs and tCFI) were 28% (95% CI: 16-43%) and 56% (95% CI: 41-70%) sensitive, respectively, p < 0.01. By the conclusion of the ED stay, sensitivities were 80% (95% CI: 66-90%) and 90% (95% CI: 78-97%), p > 0.05, and specificities were 97% (95% CI: 96-97%) and 95% (95% CI: 95-96%), p < 0.001. ED patients who developed septic shock requiring vasopressors often presented normotensive with non-specific complaints, necessitating a low threshold for clinical concern-for-infection at triage.
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|a Article
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|t Scientific Reports
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