Impact of a qSOFA-based triage procedure on antibiotic timing in ED patients with sepsis: A prospective interventional study - 19/05/20

Doi : 10.1016/j.ajem.2019.05.022

Julien Petit, MD ^a, Julien Passerieux, MD ^a, Olivier Maître, MD ^a, Charlotte Guérin, MD ^a, Clément Rozelle, MD ^a, Olivier Cordeau, MD ^a, Aline Cassonnet, HN ^a, Anne Malet, MD ^a, Thierry Boulain, MD ^b, François Barbier, MD PhD ^b,^{^⁎}
for the
qSOFAST study group
Catherine Bellec, MD, Victoria Carré, MD, Cherki Elhadj, MD, Olivier Cordeau, MD, Nathalie Delorme, MD, Pascal Ducroquet, MD, Lida Ebrahim, MD, Sylvain Gauffre, MD, Olivier Giovannetti, MD MSc, Charlotte Guérin, MD, Audrey Guérineau, MD, Matthieu Lacroix, MD, Maxence Leclerc, MD, Rémi Leclerc, MD, Florent Maillard, MD, Olivier Maitre, MD, Anne Malet, MD, Karim Mediouni, MD, Nesrine Nabli, MD, Julien Passerieux, MD, Camille Pelletier, MD, Julien Petit, MD, Dan Popescu, MD, Clément Rozelle, MD, Lavinia Stoican, MD, Jacqueline Surville, MD, Edem Tsegan-Yawo, MD
Emergency Department, La Source hospital, CHR Orléans, Orléans, France

^a Emergency Department, La Source Hospital, CHR Orléans, Orléans, France
^b Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France

^⁎Corresponding author at: Médecine Intensive et Réanimation, Hôpital de la Source, Centre Hospitalier Régional d'Orléans, 14, Boulevard de l'Hôpital, 45100 Orléans, France.Médecine Intensive et RéanimationHôpital de la Source, Centre Hospitalier Régional d'Orléans14, Boulevard de l'HôpitalOrléans45100France

Abstract

Background

It has not been investigated whether the quick sepsis-related organ failure assessment score (qSOFA), a new bedside tool for early sepsis detection, may help accelerating antibiotic initiation in ED patients with sepsis.

Methods

In this prospective pre/post quasi-experimental single-ED study, patients admitted with a suspected bacterial infection were managed using standard triage procedures only (baseline) or in association with qSOFA (intervention, with prioritization of patients with a qSOFA ≥ 2).

Results

A total of 151/328 (46.0%) and 185/350 (52.8%) patients with definite bacterial infection met the criteria for sepsis in the baseline and intervention periods, respectively. The sensitivity and specificity of a qSOFA ≥ 2 for sepsis prediction were 17.3% (95% confidence interval [CI], 13.6%–21.7%) and 98.8% (95% CI, 97.0%–99.5%). Eleven (7.3%) and 28 (13.5%) patients with sepsis in the baseline and intervention periods received a first antibiotic dose within one hour following triage (primary endpoint, absolute difference 6.2%, 95% CI [−0.5%, 12.7%], P = 0.08). The proportions of patients with sepsis receiving a first antibiotic dose within three hours following triage (39.7% [50/151] versus 36.8% [68/185], absolute difference − 2.9%, 95% CI [−13.3%, 7.3%], P = 0.65), requiring ICU admission, or dying in the hospital were similar in both periods. The median ED occupation rate at triage was 104.3% (interquartile range [IQR], 80.4%–128.3%), with a median number of 157 ED visits per day (IQR, 147–169).

Conclusions

A qSOFA-based triage procedure does not improve antibiotic timing and outcomes in patients with sepsis admitted to a high-volume ED. The qSOFA value at triage was poorly sensitive for early sepsis detection.

Trial registration (ClinicalTrials.gov): NCT03299894.

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Keywords : Sepsis, Septic shock, Antimicrobial agents, Quick sepsis-related organ failure assessment (qSOFA), Sepsis-related organ failure assessment (SOFA)

Plan

Introduction

Methods

Design and setting

Selection of participants and data collection

Study endpoints in patients with sepsis

Clinical significance of a qSOFA value ≥ 2

Discussion

Conclusion

Author contributions

Ethics approval and consent to participate

Declaration of competing interests

Availability of data and material

Funding

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Vol 38 - N° 3

P. 477-484 - mars 2020 Retour au numéro

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Impact of a qSOFA-based triage procedure on antibiotic timing in ED patients with sepsis: A prospective interventional study - 19/05/20

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Plan

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