Can Sepsis Be Detected in the Nursing Home Prior to the Need for Hospital Transfer?
Can Sepsis Be Detected in the Nursing Home Prior to the Need for Hospital Transfer?
复制标题
DOI：
10.1016/j.jamda.2018.02.001
复制
发表时间：
2018-06-01
影响因子：
7.6
通讯作者：
Zimmerman, Sheryl
中科院分区：
文献类型：
--
作者：
Sloane, Philip D.;Ward, Kimberly;Zimmerman, Sheryl
目的：为了确定是否以及在何种程度上简单的筛选工具可能会识别护理之家（NH）居民谁是在高风险成为sepatory.Design：回顾性图表审计的所有居民谁已住院，并返回到参与NHs在研究期间。共有236名NH居民，其中59人从医院返回，诊断为脓毒症，177人出院诊断为非脓毒症，从31个典型的美国疗养院的社区NHs.Measures：NH文件的生命体征，精神状态的变化，和医疗提供者访问0-12和13-72小时前住院。评价了5种筛查工具在住院前0-12和13-72小时内检测早期脓毒症居民的能力的特异性和灵敏度：全身炎症反应综合征标准，快速序贯器官衰竭评估（SOFA），100-100-100早期检测工具，温度阈值分别为99.0华氏度和100.2华氏度。此外，为了验证医院的败血症诊断，在NHS的出院记录进行了审计，计算SOFA scores.Results：1个或多个生命体征的文件是缺席的情况下，26%-34%。在有完整生命体征记录的患者中，在住院前12小时内，最敏感的筛查工具是100-100-100标准（79%）和口腔温度>99.0华氏度（51%）;最具体的工具是温度>100.2华氏度（93%），快速SOFA（88%），全身炎症反应综合征标准（86%），温度>99.0华氏度（85%）。许多SOFA数据点从记录中丢失，尽管如此，65%的情况下符合标准的sepsis.Conclusions：NH需要更好的系统来监测NH居民的状态正在发生变化，并提出该信息的医疗提供者在真实的时间，无论是通过快速医疗反应计划或遥测。(C)2018年AMDA -急性后和长期护理医学协会。
Objectives: To determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic.Design: Retrospective chart audit of all residents who had been hospitalized and returned to participating NHs during the study period.Setting and Participants: A total of 236 NH residents, 59 of whom returned from hospitals with a diagnosis of sepsis and 177 who had nonsepsis discharge diagnoses, from 31 community NHs that are typical of US nursing homes overall.Measures: NH documentation of vital signs, mental status change, and medical provider visits 0-12 and 13-72 hours prior to the hospitalization. The specificity and sensitivity of 5 screening tools were evaluated for their ability to detect residents with incipient sepsis during 0-12 and 13-72 hours prior to hospitalization: The Systemic Inflammatory Response Syndrome criteria, the quick Sequential Organ Failure Assessment (SOFA), the 100-100-100 Early Detection Tool, and temperature thresholds of 99.0 degrees F and 100.2 degrees F. In addition, to validate the hospital diagnosis of sepsis, hospital discharge records in the NHs were audited to calculate SOFA scores.Results: Documentation of 1 or more vital signs was absent in 26%-34% of cases. Among persons with complete vital sign documentation, during the 12 hours prior to hospitalization, the most sensitive screening tools were the 100-100-100 Criteria (79%) and an oral temperature >99.0 degrees F (51%); and the most specific tools being a temperature >100.2 degrees F (93%), the quick SOFA (88%), the Systemic Inflammatory Response Syndrome criteria (86%), and a temperature >99.0 degrees F (85%). Many SOFA data points were missing from the record; in spite of this, 65% of cases met criteria for sepsis.Conclusions: NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.