Usefulness of Routine qSOFA Calculation at Triage to Fasten Antimicrobial Administration in Patients With Bacterial Infection in the Emergency Department: a Quasi-experimental Study
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 780
- 试验地点
- 2
- 主要终点
- Proportion of patients who receive a first dose of antimicrobial agent
研究概览
简要总结
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).
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 105 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Suspected or proven bacterial infection at emergency department triage
排除标准
- •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
研究组 & 干预措施
systematic calculation of qSOFA
Usual procedure for patient triage AND systematic calculation of qSOFA at Emergency Department triage in patients admitted with a suspected or proven bacterial infection.
干预措施: systematic calculation of qSOFA (Procedure)
no systematic calculation of qSOFA
Usual procedures for patient triage at Emergency Department admission and management of suspected or proven bacterial infection. No systematic calculation of qSOFA.
结局指标
主要结局
Proportion of patients who receive a first dose of antimicrobial agent
时间窗: 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.
次要结局
- Proportion of patients who receive a first dose of adequate antimicrobial agent(three hours)
- In-hospital mortality at day 7(seven days)
- Proportion of patients who receive a first dose of antimicrobial agent(three hours)
- Proportion of patients with a decrease in SOFA score value ≥ 1 point(two days)
- Proportion of patients requiring an admission to the Intensive Care Unit(two days)
- Length of hospital stay(throught hospital discharge, up to 3 months)
- Overall In-hospital mortality(through hospital discharge, up to 3 months)