Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients

American Surgeon - Tập 81 Số 10 - Trang 1074-1079 - 2015
Ian T. MacQueen1,2, Aaron J. Dawes1,2,3, Tracy N. Hadnott4, Kristen Strength5, Gregory J. Moran6,7, Christine H. Holschneider5,8, Marcia M. Russell1,2, Melinda Maggard‐Gibbons1,2,9
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
2Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
3VA/Robert Wood Johnson Foundation Clinical Scholars Program, Los Angeles, California;
4Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California
5David Geffen School of Medicine at UCLA, Los Angeles, California
6Departments of Emergency Medicine, Olive View-UCLA Medical Center, Sylmar, California
7Departments of Infectious Disease, Olive View-UCLA Medical Center, Sylmar, California
8Departments of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, California
9Departments of Surgery, Olive View-UCLA Medical Center, Sylmar, California

Tóm tắt

Sepsis remains a significant source of mortality among hospitalized patients. This study examines the usage of a vital sign-based screening protocol in identifying postoperative patients at risk for sepsis at an academic-affiliated medical center. We identified all general surgery inpatients undergoing abdominopelvic surgery from January to June 2014, and compared those with positive screening tests to a sample of screen-negative controls. Multivariate logistic regression was used to identify predictors of positive screening tests and progression to severe sepsis. In total, 478 patients underwent abdominopelvic operations, 59 had positive screening tests, 33 qualified for sepsis, and six progressed to severe sepsis. Predictors of a positive screening test were presence of cancer [odds ratio (OR) 30.7, 95% confidence interval (CI) 2.2–420], emergency operation (OR 6.5, 95% CI 1.7–24), longer operative time (OR 2.2/h, 95% CI 1.2–4.1), and presence of postoperative infection (OR 6.4, 95% CI 1.5–27). The screening protocol had sensitivity 100 per cent and specificity 88 per cent for severe sepsis. We identified no predictors of severe sepsis. In conclusion, vital sign-based screening provides value by drawing early attention to patients with potential to develop sepsis, but escalation of care for these patients should be based on clinical judgment.

Từ khóa


Tài liệu tham khảo

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American Surgeon

Tập 81 Số 10

1074-1079

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