1236. Performance of a Sepsis Screening Triage Tool in Patients with Elevated Lactic Acid Levels: A Retrospective Chart Review
Session: Poster Abstract Session: Sepsis and Critical Care
Saturday, October 22, 2011
Room: Poster Hall B1
Background: 

Early recognition and treatment of severe sepsis is critical. It is well accepted that an elevated serum lactic acid level is associated with sepsis, strenuous exercise, heart failure, ischemia and/or liver damage. This study’s goal was to assess whether a triage screening tool, in use at Lutheran Medical Center, was able to identify Emergency Department (ED) patients with potential infection who had elevated serum lactate levels.

Methods: 

All medical/surgical admissions from the ED from May to October 2010 with serum lactate of ≥ 4 mmol/l were retrospectively evaluated for possible sepsis.  Patients were screened for sepsis using a 7 component triage screening tool: 1) presence of a suspected infection, 2) temp > 100.4 or < 96.5, 3) HR > 90, 4) RR > 20, 5) alteration of mental status, 6) O2 saturation < 90%, and 7) Syst. BP < 90. Presence of >3 components constituted a positive sepsis screen. Data were collected using the electronic medical record. Each case was divided into one of three groups of admitting diagnoses: infectious, noninfectious, and unknown etiology.

Results: 

Of the 179 total patients with lactic acid levels > 4 mmol/l, 69 (39%) had an admitting diagnosis of an infectious etiology; 77 (43%) a non-infectious etiology; and 33 (18%) an unknown etiology. Of the 69 patients with an infectious etiology, 48 (70%) were screened in using the triage screening tool. Of those 48 patients, 12 (17%) met three categories, 16 (23%) met four categories, 15 (22%) met five categories, 4 (6%) met six categories, and 1 (1%) met all seven categories. Of the patients with an infectious etiology, 25% screened positive for variances in temperature, compared to 8% and 3% with non-infectious and unknown etiologies, respectively; 47% screened positive for changes in mental status, compared to 68% and 36% with non-infectious and unknown etiologies, respectively; and 26% screened positive for decreased oxygen saturation, compared to 10% and 15% with non-infectious and unknown etiologies, respectively.

Conclusion: 

The data suggest that our triage screening tool identified 70% of ED patients with a lactate level > 4 mmol/l and an infection-related admission diagnosis. Providers should  use this tool in conjunction with other elements when identifying patients with sepsis.


Subject Category: J. Clinical practice issues

Ramzy Rimawi, MD1, Carlo Palarca, MD1, Nicolas Aquino, MD1, Dhaval Thakkar2, Namita Bhardwaj2, David Tompkins, MD1, Beth Raucher, MD2, Tom-Meka Archinard, MD3 and Michelle Quash, MD3, (1)Internal Medicine, Lutheran Medical Center, Brooklyn, NY, (2)Lutheran Medical Center, Brooklyn, NY, (3)Emergency Medicine, Lutheran Medical Center, Brooklyn, NY

Disclosures:

R. Rimawi, None

C. Palarca, None

N. Aquino, None

D. Thakkar, None

N. Bhardwaj, None

D. Tompkins, None

B. Raucher, None

T. M. Archinard, None

M. Quash, None

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