Bacterial Infection, Intensive Care
Conditions
Keywords
Sepsis, Shock, septic, Emergency service, hospital, Anti-infective agents, Outcome assessment
Brief summary
The delayed administration of an adequate antimicrobial therapy is a strong predictor of impaired outcome in patients with bacterial sepsis. Therefore, the current Surviving Sepsis Campaign guidelines (2016) recommend that administration of intravenous antimicrobials be initiated within one hour following the recognition of sepsis or septic shock. The quick Sepsis-related Organ Failure Assessment (qSOFA) score is a new bedside tool which has been recently proposed by the Third International Sepsis Consensus Definitions Task Force (Sepsis-3) to identify patients with suspected infection who are at greater risk for a poor outcome outside the Intensive Care Unit (ICU). It uses three criteria, assigning one point for low systolic blood pressure (SBP ≤100 mmHg), high respiratory rate (≥22 breaths per min) and altered mentation (Glasgow coma scale \<15). The score ranges from 0 to 3 points. A qSOFA value ≥2 points is associated with a greater risk of death or prolonged ICU stay, these outcomes being more common in infected patients who may be septic than in those with uncomplicated infection. The definite goal of qSOFA is to hasten the management and thus improve the outcome of patients at risk of sepsis or septic shock. Many patients admitted to the hospital for bacterial sepsis or septic shock are initially managed in the Emergency Department (ED). This study aims at investigating whether the routine calculation of qSOFA at patient triage may hasten the initiation of antimicrobial therapy in patients admitted to the ED with suspected or proven bacterial infection, especially in those with subsequent criteria for sepsis or septic shock (Sepsis-3 definition).
Interventions
PROCEDUREsystematic calculation of qSOFA
calculation of qSOFA for each patient
Sponsors
Centre Hospitalier Régional d'Orléans
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Patients will be prospectively included at Emergency Department triage during 2 consecutive 6-month periods (1-month wash-out interlude between the 2 inclusion periods): * First inclusion period: usual procedures for patient triage at Emergency Department admission and management of suspected or proven bacterial infection. * Second inclusion period: usual procedure for patient triage at Emergency Department admission PLUS routine calculation of qSOFA in all patients admitted to the Emergency Department with a suspected or proven bacterial infection. Patients with a qSOFA value ≥2 will be directly and immediately notified to Emergency Department physicians by triage nurses.
Eligibility
Sex/Gender
ALL
Age
18 Years to 105 Years
Healthy volunteers
No
Inclusion criteria
• Suspected or proven bacterial infection at emergency department triage
Exclusion criteria
* Imminent death * Pregnancy * Breast-feeding * For patients managed by a medicalized pre-hospital emergency team before ED admission : administration of a first dose of antimicrobial agent before ED admission * Lack of coverage by the public health insurance system * Patient's refusal for study enrollment * Lack of confirmed bacterial infection (i.e., documented either clinically, microbiologically or by imaging procedures) in patients with a suspected bacterial infection at emergency departement triage
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients who receive a first dose of antimicrobial agent | one hour | Proportion of patients with criteria for sepsis or septic shock (Sepsis-3 definition) who receive a first dose of antimicrobial agent within one hour following triage in the emergency department. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients who receive a first dose of antimicrobial agent | three hours | Proportion of patients with criteria for sepsis or septic shock (Sepsis-3 definition) who receive a first dose of antimicrobial agent within 3 hours following triage in the emergency department. |
| Proportion of patients requiring an admission to the Intensive Care Unit | two days | Proportion of patients requiring an admission to the Intensive Care Unit between triage in the emergency department (Day 0) and Day 2 |
| Proportion of patients with a decrease in SOFA score value ≥ 1 point | two days | Proportion of patients with a decrease in SOFA score value ≥ 1 point between triage in the emergency department (Day 0) and Day 2 among those with an initial SOFA score value ≥ 1 point |
| Proportion of patients who receive a first dose of adequate antimicrobial agent | one hour | Proportion of patients with criteria for sepsis or septic shock (Sepsis-3 definition) and microbiologically documented infection who receive a first dose of adequate antimicrobial agent within one hour following triage in the emergency department. |
| Overall In-hospital mortality | through hospital discharge, up to 3 months | Number of patients who died in hospital during the hospital stay |
| Length of hospital stay | throught hospital discharge, up to 3 months | Number of days in hospital |
| In-hospital mortality at day 7 | seven days | Number of patients who died in hospital at day 7 |
Countries
France
Outcome results
None listed