背景:没有通用的触发因素或工具来辅助败血症诊断。
目的:本研究的目的是确定触发因素和工具,以帮助早期发现脓毒症,这些因素和工具可以在各种医疗机构中轻松实施。
方法:使用MEDLINE进行系统综合评价,CINAHL,EMBASE,Scopus,和Cochrane系统评价数据库。相关灰色文献和主题专家咨询也为审查提供了信息。研究类型包括系统评价,随机对照试验,和队列研究。院前的所有患者群体,急诊科,和急性医院住院设置,不包括重症监护室,包括在内。评估了脓毒症触发因素和工具在检测脓毒症中的功效以及与过程措施和患者预后的关联。使用乔安娜·布里格斯研究所的工具对方法学质量进行了评估。
结果:在纳入的124项研究中,大多数是急诊科(44.4%)内成人(83.9%)的回顾性队列(49.2%).最常评估的脓毒症工具是qSOFA(12项研究)和SIRS(11项研究),中位灵敏度为28.0%对51.0%,特异性为98.0%对82.0%。分别,用于败血症诊断。乳酸加qSOFA(两项研究)的敏感性在57.0%至65.5%之间,而国家早期预警评分(四项研究)显示中位灵敏度和特异性>80%,但后者被认为难以实施。在触发器中,阈值≥2.0mmol/L的乳酸(18项研究)对预测脓毒症相关临床恶化的敏感性高于<2.0mmol/L。自动脓毒症警报和算法(35项研究)显示,中位灵敏度在58.0和80.0%之间,特异性在60.0和93.1%之间。其他脓毒症工具和产妇的数据有限,儿科,和新生儿群体。总体方法学质量较高。
结论:没有单一的脓毒症工具或触发因素适用于各种环境和人群,但是考虑到有效性和易于实施,有证据表明,成人患者使用乳酸+qSOFA.在产妇方面需要更多的研究,儿科,和新生儿群体。
There is no universal trigger or tool to aid sepsis diagnosis.
The objective of this study was to identify
triggers and tools to assist the early detection of sepsis that can be readily implemented across various health care settings.
A systematic integrative
review was conducted using MEDLINE, CINAHL, EMBASE, Scopus, and the Cochrane Database of Systematic Reviews. Relevant grey literature and subject-matter expert consultation also informed the
review. Study types included systematic reviews, randomised controlled trials, and cohort studies. All patient populations across prehospital, emergency department, and acute hospital inpatient settings, excluding the intensive care unit, were included. Sepsis
triggers and tools were evaluated for efficacy in detecting sepsis and association with process measures and patient outcomes. Methodological quality was appraised using Joanna Briggs Institute tools.
Of the 124 included studies, most were retrospective cohort (49.2%) in adults (83.9%) within the emergency department (44.4%). The most commonly evaluated sepsis tools were qSOFA (12 studies) and SIRS (11 studies) with a median sensitivity of 28.0% versus 51.0% and a specificity of 98.0% versus 82.0%, respectively, for sepsis diagnosis. Lactate plus qSOFA (two studies) had a sensitivity between 57.0 and 65.5%, whereas the National Early Warning Score (four studies) demonstrated median sensitivity and specificity >80%, but the latter was considered difficult to implement. Amongst
triggers, lactate (18 studies) at the threshold of ≥2.0 mmol/L showed higher sensitivity for predicting sepsis-related clinical deterioration than <2.0 mmol/L. Automated sepsis alerts and algorithms (35 studies) showed median sensitivity between 58.0 and 80.0% and specificity between 60.0 and 93.1%. There were limited data for other sepsis tools and maternal, paediatric, and neonatal populations. Overall methodological quality was high.
No single sepsis tool or trigger is applicable across various settings and populations, but considering efficacy and ease of implementation, there is evidence to use lactate plus qSOFA for adult patients. More research is needed in maternal, paediatric, and neonatal populations.