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Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit.
Eur J Emerg Med. 2014 Aug; 21(4):254-9.EJ

Abstract

OBJECTIVES

The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay.

MATERIALS AND METHODS

Mortality in Emergency Department Sepsis (MEDS), Acute Physiology Age Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) score (SOFA-T0) and the Charlson index were calculated at ED admission. SOFA score was also calculated after 24 h (SOFA-T1). The primary outcome was 28 days mortality.

RESULTS

We admitted 140 patients with severe sepsis or septic shock in our ED-HDU from June 2008 to December 2010; 135 were included in the study. One month's mortality was 29%. SOFA-T1 was significantly higher in patients who needed an ICU admission (7.5±3.8 vs. 5.3±3.0, P=0.048); it also showed the best mortality prediction ability (area under the curve 0.80, 95% confidence interval 0.70-0.91), compared with MEDS, SAPS, and APACHE score. Troponin and procalcitonin evaluated at ED admission and after 24 h did not show significant differences according to prognosis; patients with lactate more than 2 showed a higher mortality (40 vs. 22%, P=0.034). In a regression analysis adjusted for age, lactate value, and the Charlson index, SOFA-T1 (RR 1.551, 95% confidence interval 1.204-1.998, P<0.001) maintained an independent prognostic value for 28 days mortality. During the 267 days of stay at the ED-HDU, the total saving was &OV0556;460 041, compared with the cost of the same period in the ICU.

CONCLUSION

SOFA score is a feasible and accurate tool for an early risk stratification of septic patients admitted to the ED-HDU.

Authors+Show Affiliations

High Dependency Unit, Department of Critical Care Medicine and Surgery, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23970100

Citation

Innocenti, Francesca, et al. "Prognostic Scores for Early Stratification of Septic Patients Admitted to an Emergency Department-high Dependency Unit." European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, vol. 21, no. 4, 2014, pp. 254-9.
Innocenti F, Bianchi S, Guerrini E, et al. Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit. Eur J Emerg Med. 2014;21(4):254-9.
Innocenti, F., Bianchi, S., Guerrini, E., Vicidomini, S., Conti, A., Zanobetti, M., & Pini, R. (2014). Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit. European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine, 21(4), 254-9. https://doi.org/10.1097/MEJ.0000000000000075
Innocenti F, et al. Prognostic Scores for Early Stratification of Septic Patients Admitted to an Emergency Department-high Dependency Unit. Eur J Emerg Med. 2014;21(4):254-9. PubMed PMID: 23970100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit. AU - Innocenti,Francesca, AU - Bianchi,Simone, AU - Guerrini,Elisa, AU - Vicidomini,Sonia, AU - Conti,Alberto, AU - Zanobetti,Maurizio, AU - Pini,Riccardo, PY - 2013/8/24/entrez PY - 2013/8/24/pubmed PY - 2015/4/22/medline SP - 254 EP - 9 JF - European journal of emergency medicine : official journal of the European Society for Emergency Medicine JO - Eur J Emerg Med VL - 21 IS - 4 N2 - OBJECTIVES: The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay. MATERIALS AND METHODS: Mortality in Emergency Department Sepsis (MEDS), Acute Physiology Age Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) score (SOFA-T0) and the Charlson index were calculated at ED admission. SOFA score was also calculated after 24 h (SOFA-T1). The primary outcome was 28 days mortality. RESULTS: We admitted 140 patients with severe sepsis or septic shock in our ED-HDU from June 2008 to December 2010; 135 were included in the study. One month's mortality was 29%. SOFA-T1 was significantly higher in patients who needed an ICU admission (7.5±3.8 vs. 5.3±3.0, P=0.048); it also showed the best mortality prediction ability (area under the curve 0.80, 95% confidence interval 0.70-0.91), compared with MEDS, SAPS, and APACHE score. Troponin and procalcitonin evaluated at ED admission and after 24 h did not show significant differences according to prognosis; patients with lactate more than 2 showed a higher mortality (40 vs. 22%, P=0.034). In a regression analysis adjusted for age, lactate value, and the Charlson index, SOFA-T1 (RR 1.551, 95% confidence interval 1.204-1.998, P<0.001) maintained an independent prognostic value for 28 days mortality. During the 267 days of stay at the ED-HDU, the total saving was &OV0556;460 041, compared with the cost of the same period in the ICU. CONCLUSION: SOFA score is a feasible and accurate tool for an early risk stratification of septic patients admitted to the ED-HDU. SN - 1473-5695 UR - https://www.unboundmedicine.com/medline/citation/23970100/Prognostic_scores_for_early_stratification_of_septic_patients_admitted_to_an_emergency_department_high_dependency_unit_ L2 - https://doi.org/10.1097/MEJ.0000000000000075 DB - PRIME DP - Unbound Medicine ER -