Diagnostic Characteristics of a Clinical Screening Tool in Combination With Measuring Bedside Lactate Level in Emergency Department Patients With Suspected Sepsis

2014 ◽  
Vol 21 (8) ◽  
pp. 853-857 ◽  
Author(s):  
Adam J. Singer ◽  
Merry Taylor ◽  
Anna Domingo ◽  
Saad Ghazipura ◽  
Adam Khorasonchi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lactate Level ◽  
Screening Tool ◽  
Suspected Sepsis ◽  
Clinical Screening ◽  
Diagnostic Characteristics ◽  
Emergency Department Patients

Evaluation of the Ottawa 3DY as a screening tool for cognitive impairment in older emergency department patients

2020 ◽  
Vol 38 (12) ◽  
pp. 2545-2551 ◽  
Author(s):  
Debra Eagles ◽  
Damanjot Otal ◽  
Laura Wilding ◽  
Samir Sinha ◽  
Venkatesh Thiruganasambandamoorthy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cognitive Impairment ◽  
Screening Tool ◽  
Emergency Department Patients

Use of Physician-Estimated and Patient Self-Reported Weights to Guide Initial Fluid Resuscitation in Emergency Department Patients With Suspected Sepsis

2020 ◽  
pp. 088506662091790
Author(s):  
Jeremy K. Lessing ◽  
William J. H. Ford ◽  
Peter A. Steel ◽  
Sunday Clark ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Fluid Resuscitation ◽  
Fluid Therapy ◽  
Intravenous Fluid ◽  
Medical Providers ◽  
Suspected Sepsis ◽  
Intravenous Fluid Therapy ◽  
Multiple Levels ◽  
Emergency Department Patients ◽  
Elevated Lactate

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.

scholarly journals Content Validation of a Novel Screening Tool to Identify Emergency Department Patients With Significant Palliative Care Needs

2015 ◽  
Vol 22 (7) ◽  
pp. 823-837 ◽  
Author(s):  
Naomi George ◽  
Nina Barrett ◽  
Laura McPeake ◽  
Rebecca Goett ◽  
Kelsey Anderson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Screening Tool ◽  
Content Validation ◽  
Care Needs ◽  
Emergency Department Patients ◽  
Palliative Care Needs

scholarly journals Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Ralphe Bou Chebl ◽  
Sarah Jamali ◽  
Nancy Mikati ◽  
Reem Al Assaad ◽  
Karim Abdel Daem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Lactate Level ◽  
Reference Range ◽  
Serum Lactate ◽  
Optimal Cutoff ◽  
The Mean ◽  
Emergency Department Patients ◽  
Lactate Levels ◽  
Youden’S Index

Abstract Objective The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range. Methods This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality. Results During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD. Conclusion The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.

scholarly journals Serum lactate cut-offs asarisk stratification tool for in-hospital adverse outcomes in emergency department patients screened for suspected sepsis

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e015492 ◽  
Author(s):  
Amith L Shetty ◽  
Kelly Thompson ◽  
Karen Byth ◽  
Petra Macaskill ◽  
Malcolm Green ◽  
...  
Keyword(s):  
Emergency Department ◽  
Serum Lactate ◽  
Adverse Outcomes ◽  
Suspected Sepsis ◽  
Emergency Department Patients
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