The American journal of emergency medicine
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Comparative Study
Comparison of qSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis.
The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis. ⋯ Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes.
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Fever is one of the most common complaints in the emergency department (ED) and is more complex than generally appreciated. The broad differential diagnosis of fever includes numerous infectious and non-infectious etiologies. An essential skill in emergency medicine is recognizing the pitfalls in fever evaluation. ⋯ Any fever evaluation must rigorously maintain a broad differential to avoid pitfalls that can have patient care consequences. Fever is complex and due to a variety of etiologies. An understanding of the pathophysiology, causes, and assessment is important for emergency physicians.
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Mild induced hypothermia (MIH) was introduced for post cardiac arrest care in Sweden in 2003, based on two clinical trials. This retrospective study evaluated its association with 30-day survival after out-of-hospital cardiac arrest (OHCA) in a Swedish community from 2003 to 2015. ⋯ Treatment with MIH was not significantly associated with increased 30-day survival in patients remaining unconscious after OHCA when adjusting for potential confounders.
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It is unclear whether scene time interval (STI) is associated with better neurological recovery in the emergency medical service (EMS) system with intermediate service level. ⋯ The middle STI (4-7min) was associated with the highest odds of neurological recovery for patients who could not be restored in the field. The STI may be a clinically useful predictor of good neurology outcome in victims of cardiac arrest.
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In-hospital cardiac arrests (IHCAs) are often preceded by abnormal vital signs. Preceding abnormal vital signs might lower the physiological reserve capacity and therefore decrease survival after an IHCA. ⋯ The NEWS can be a probable proxy for estimating physiological reserve capacity since high NEWS is associated to high change of death in case of an IHCA. This information can be used when discussing prognosis with patients and relatives. But even more importantly, it stresses the need for better preventive strategies in IHCAs. STRENGTHENS AND LIMITATIONS WITH THIS STUDY.