Description

Suffoletto et al identified clinical findings associated with serious infection that can be used to evaluate a patient in the Emergency Department (ED). The authors are from the University of Pittsburgh.


 

Patient selection: serious infection (based on a diagnosis of acute infection by the ED physician AND hospital admission)

 

Clinical findings that can occur with a serious infection:

(1) systolic blood pressure < 100 mm Hg

(2) fever or suspicion of fever

(3) (respiratory rate > 20 breaths per minute) OR (pulse oximetry < 95%, presumably on room air)

(4) altered mental status

(5) heart rate > 90 beats per minute

 

Clinician suspicion of infection was not evaluated (this was a predictor in a prehospital tool in the same study).

 

50% of patients with a serious infection had 2 or more abnormal vital signs.

16% of patients had severe infection (based on admission to the ICU).

 

Limitations:

• The type of serious infections was not referenced to the clinical findings.

• The criteria for serious infection (ED physician diagnosis of infection AND hospital admission) might not be specific since a person could have been admitted for other reasons.

 

Performance:

• The most sensitive measures were heart rate, systolic blood pressure and altered mental status, which were all at 63%.

• The specificities ranged from 74% for heart rate to 94% for fever.

 


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