TY - JOUR
T1 - Evaluation of electronic measurement of capillary refill for Sepsis screening at ED triage
AU - Hansen, Matthew
AU - Gillespie, Jordan
AU - Riddick, Tyne
AU - Samatham, Ravi
AU - Baker, Steven
AU - Filer, Scott
AU - Xin, Haichang
AU - Sheridan, David
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/8
Y1 - 2023/8
N2 - Objective: To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED). Methods: This prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational medical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included patient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes. Results: We enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06–1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02–2.40), and septic shock defined as receipt of IV antibiotics and a vasopressor requirement (OR 1.37, 95% CI 1.03–1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31–16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99–7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement. Conclusions: CRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage.
AB - Objective: To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED). Methods: This prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational medical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included patient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes. Results: We enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06–1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02–2.40), and septic shock defined as receipt of IV antibiotics and a vasopressor requirement (OR 1.37, 95% CI 1.03–1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31–16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99–7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement. Conclusions: CRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage.
KW - Capillary refill time
KW - Microcirculation
KW - Septic shock
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85159401146&partnerID=8YFLogxK
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U2 - 10.1016/j.ajem.2023.05.009
DO - 10.1016/j.ajem.2023.05.009
M3 - Article
C2 - 37201452
AN - SCOPUS:85159401146
SN - 0735-6757
VL - 70
SP - 61
EP - 65
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -