Background

Sepsis is a major cause of morbidity and mortality worldwide. Early recognition and treatment of sepsis is associated with improved outcome. The emergency department (ED) is the department where patients with sepsis seek care. However, recognition of sepsis in the ED remains difficult. Different alert and triage systems, screening scores and intervention strategies have been developed to assist clinicians in early recognition of sepsis and to optimize management.

Objectives

This narrative review describes currently applied interventions or interventions we can start using today, such as screening scores, (automated) triage systems, sepsis teams and clinical pathways in sepsis care; and it summarizes evidence for the effect of implementation of these interventions in the ED on patient management and outcomes.

Sources

A systematic literature search was conducted in PubMed, resulting in 39 eligible studies.

Content

The main sepsis interventions in the ED are (automated) triage systems, sepsis teams and clinical pathways, the most integrative being a clinical pathway. Implementation of any of these interventions in sepsis care will generally lead to increased protocol adherence. Presumably increased adherence to sepsis guidelines and bundles will lead to better patient outcomes, but the level of evidence to support this improvement is low, whereas implementation of interventions is often complex and costly. No studies comparing different interventions were identified. Two essential factors for success of interventions in the ED are obtaining the support from all professionals and providing ongoing education. The vulnerability of these interventions lies in the lack of accurate tools to identify sepsis; diagnosing sepsis ultimately still relies on clinical assessments. A lack of specificity or sepsis alerts may lead to alert fatigue and/or overtreatment.

Implications

The severity and poor outcome of sepsis as well as the frequency of its presentation in EDs make a structured, protocol-based approach towards these patients essential, preferably as part of a clinical pathway.

中文翻译：

---

急诊科败血症快速识别和治疗的干预措施：叙述性回顾

背景

败血症是全世界发病率和死亡率的主要原因。败血症的早期识别和治疗可改善预后。急诊科（ED）是败血症患者就诊的部门。然而，在ED中识别败血症仍然是困难的。已经开发出不同的警报和分类系统，筛查分数和干预策略，以帮助临床医生及早识别败血症并优化管理。

目标

这篇叙述性评论描述了当前应用的干预措施或我们今天可以开始使用的干预措施，例如筛查分数，（自动）分类系统，脓毒症小组和脓毒症护理的临床途径；并且总结了在急诊中实施这些干预措施对患者管理和结果的影响的证据。

资料来源

在PubMed中进行了系统的文献检索，得出39项合格研究。

内容

急诊部的主要败血症干预措施是（自动）分类系统，败血症团队和临床途径，其中最综合的是临床途径。在脓毒症护理中实施这些干预措施中的任何一项通常会导致增加治疗方案依从性。据推测，增加对脓毒症指南和捆绑疗法的依从性将导致更好的患者预后，但支持这种改善的证据水平较低，而干预措施的实施通常是复杂且昂贵的。没有发现比较不同干预措施的研究。急诊室干预成功的两个基本因素是获得所有专业人员的支持并提供持续的教育。这些干预措施的脆弱性在于缺乏识别败血症的准确工具。诊断败血症最终仍需依靠临床评估。缺乏特异性或败血症警报可能会导致警报疲劳和/或过度治疗。

含义

败血症的严重程度和不良后果以及其在急诊室就诊的频率使得针对这些患者的结构化，基于方案的治疗方法至关重要，最好将其作为临床途径的一部分。