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Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis.
J Intensive Care Med. 2020 Apr 22 [Online ahead of print]JI

Abstract

BACKGROUND

Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information.

OBJECTIVES

This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis.

METHODS

Adult patients presenting with a suspected diagnosis of severe sepsis to a large, urban, academic emergency department had either physician-estimated or patient self-reported weights recorded on presentation. All patients had subsequent inpatient bed/stretcher scale weights recorded on the first day of hospitalization.

RESULTS

Physician-estimated and patient self-reported weights linearly correlated (P < .001) with inpatient bed/stretcher scale weights. Median accuracy error for physicians (5.4% [2.0-10.1]) and patients (3.9% [1.6-6.4]) was not significantly different (P = .28). Physician-estimated and patient self-reported weights accuracy was determined at multiple levels: within 5% (46%, 57%, respectively), 10% (75%, 90%), 15% (90%, 95%), and 20% (100%, 95%) error tolerances, as well accurate estimates within 5 kg (69.2%, 70.0%).

CONCLUSIONS

Both physician-estimated and patient self-reported weights are reliable when calculating initial protocol-based intravenous fluid resuscitation for emergency department patients with sepsis.

Authors+Show Affiliations

Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA.Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA.Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA.Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA.Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA.Division of Emergency Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY,USA. Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32319348

Citation

Lessing, Jeremy K., et al. "Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis." Journal of Intensive Care Medicine, 2020, p. 885066620917902.
Lessing JK, Ford WJH, Steel PA, et al. Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis. J Intensive Care Med. 2020.
Lessing, J. K., Ford, W. J. H., Steel, P. A., Clark, S., Sharma, R., & Arbo, J. E. (2020). Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis. Journal of Intensive Care Medicine, 885066620917902. https://doi.org/10.1177/0885066620917902
Lessing JK, et al. Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis. J Intensive Care Med. 2020 Apr 22;885066620917902. PubMed PMID: 32319348.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis. AU - Lessing,Jeremy K, AU - Ford,William J H, AU - Steel,Peter A, AU - Clark,Sunday, AU - Sharma,Rahul, AU - Arbo,John E, Y1 - 2020/04/22/ PY - 2020/4/23/entrez KW - emergency medicine KW - patient weight KW - resuscitation KW - sepsis SP - 885066620917902 EP - 885066620917902 JF - Journal of intensive care medicine JO - J Intensive Care Med N2 - BACKGROUND: Knowledge of patient weight is required to guide initial intravenous fluid therapy for patients with sepsis-associated hypotension or elevated lactate. Previous studies have shown patients are better estimators of their weight than medical providers are; critically ill patients, however, may be unable to provide this information. OBJECTIVES: This study compares the accuracy of physician-estimated and patient self-reported weights to subsequent inpatient bed/stretcher scale weights for guiding initial protocol-based intravenous fluid therapy in the treatment of emergency department patients with suspected sepsis. METHODS: Adult patients presenting with a suspected diagnosis of severe sepsis to a large, urban, academic emergency department had either physician-estimated or patient self-reported weights recorded on presentation. All patients had subsequent inpatient bed/stretcher scale weights recorded on the first day of hospitalization. RESULTS: Physician-estimated and patient self-reported weights linearly correlated (P < .001) with inpatient bed/stretcher scale weights. Median accuracy error for physicians (5.4% [2.0-10.1]) and patients (3.9% [1.6-6.4]) was not significantly different (P = .28). Physician-estimated and patient self-reported weights accuracy was determined at multiple levels: within 5% (46%, 57%, respectively), 10% (75%, 90%), 15% (90%, 95%), and 20% (100%, 95%) error tolerances, as well accurate estimates within 5 kg (69.2%, 70.0%). CONCLUSIONS: Both physician-estimated and patient self-reported weights are reliable when calculating initial protocol-based intravenous fluid resuscitation for emergency department patients with sepsis. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/32319348/Use_of_Physician-Estimated_and_Patient_Self-Reported_Weights_to_Guide_Initial_Fluid_Resuscitation_in_Emergency_Department_Patients_With_Suspected_Sepsis L2 - https://journals.sagepub.com/doi/10.1177/0885066620917902?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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