The value of the clinical impression in recognizing and treating sepsis patients in the emergency department

摘要

Objectives: Immediate bedside recognition of sepsis in the emergency department (ED) enables early treatment. This study aims to investigate whether the clinical impression score of different health care providers (a) is a good predictor of the severity of sepsis, (b) is mutually agreed, and (c) correlates with the treatment provided in the ED. Methods: We performed a prospective observational study in the ED of a tertiary teaching hospital over a 3-month period. The vital signs of all patients of at least 18 years presenting with suspected infection or sepsis were measured on arrival at the ED. In patients with at least one of the 'Systemic Inflammatory Response Syndrome' criteria, the nurse, resident, and attending physician assigned a clinical impression score for the degree of acute illness, ranging from 1 (not ill) to 10 (extremely ill). Additional information collected included demographic and treatment data. Results: We included 123 patients with sepsis and 11 patients with a (suspected) infection with one 'Systemic Inflammatory Response Syndrome' criterion. The clinical impression scores of all health care providers increased significantly between the infection without sepsis, mild sepsis, and severe sepsis groups. The agreement between the health care providers ranged from moderate to good (weighted κ 0.54-0.62). The clinical impression score correlated with time to antibiotics (R=-0.33, P=0.001), amount of volume therapy (R=0.61-0.64, P≤0.001), and amount of oxygen therapy (R=0.58-0.63, P≤0.001). Conclusion: The clinical impression score is associated with the severity of sepsis, is mutually agreed between the different health care providers and is correlated with sepsis treatment provided in the ED.