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The Epidemiology and Approach to Differentiating Etiologies of Shock in the Emergency Department

Establishing a Tool to Increase the Accuracy of Emergency Physicians Diagnosing Etiologies of Shock

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT02164799
Enrollment
2500
Registered
2014-06-17
Start date
2012-11-30
Completion date
Unknown
Last updated
2014-06-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Undifferentiated Shock

Keywords

Shock, Predicting diagnosis, Predicting adverse outcomes

Brief summary

The Shock Tool study is designed to improve the clinical evaluation for differentiating shock in the emergency department. The goal of this study is to evaluate and improve the accuracy of physicians differentiating causes of shock.

Detailed description

Specific Aim #1: To study the epidemiology of shock in the emergency department Hypothesis 1: We will better understand shock states if we determine shock etiology among patients presenting to the emergency department in a carefully conducted observational prospective study. Specific Aim #2: To determine the accuracy of physician diagnosis for the underlying etiology of shock. Hypothesis 2: Physician assessment of the underlying cause of shock is challenging and often inaccurate in the early stages of care in the emergency department. Specific Aim #3: To optimize the evidence-based approach to assist in the diagnosis of shock etiology from elements readily available when a patient demonstrates shock physiology in the Emergency Department. Hypothesis 3: An evidenced-based, standardized approach to clinical decision making integrating elements of the history, physical exam, and early testing will improve a physician's ability to accurately differentiate etiologies of shock.

Interventions

None listed

Sponsors

Beth Israel Deaconess Medical Center
Lead SponsorOTHER

Study design

Observational model
COHORT
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Age 18 years or great * For pre-shock cohort: HR \> 130, RR\>24, Shock index \> 1, lactate \> 4.0mmol/L, SBP \< 90mm/hg) * For shock cohort: persistent blood pressure \<90mm/hg after resuscitation

Exclusion criteria

* seizure * isolated atrial fibrillation with discharge after rate control achieved * discharged from the emergency department * intoxication or withdrawal

Design outcomes

Primary

MeasureTime frameDescription
Etiology of ShockRetrospectively, 1 month after enrollmentEach patient determined to have shock in the emergency department is given a single diagnosis by a reviewing physician after the hospital course is completed.

Secondary

MeasureTime frameDescription
In hospital mortalityThis measure will be assessed at the time of physician review after discharge from hospital, on average 2 months after initial ED visit.Death by any cause during hospitalization

Other

MeasureTime frameDescription
DeteriorationThis measure will be assessed at the time of physician review after discharge from hospital, on average 2 months after initial ED visit.A composite outcome met if any of the following are present during hospitalization: acute renal failure (creatinine 2x baseline or new initiation of dialysis), non-elective intubation, vasopressor requirement, or mortality.

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026