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Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring
Author(s) -
Shetty Amith,
Macdonald Stephen PJ,
Keijzers Gerben,
Williams Julian M,
Tang Benjamin,
de Groot Bas,
Thompson Kelly,
Fraser John F,
Finfer Simon,
Bellomo Rinaldo,
Iredell Jonathan
Publication year - 2018
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12924
Subject(s) - medicine , sepsis , intensive care medicine , septic shock , emergency department , biomarker , organ dysfunction , immunology , biochemistry , chemistry , psychiatry
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials. Routine laboratory investigations such as creatinine, bilirubin, platelet count and lactate are now critical elements in the diagnosis of sepsis and septic shock. With no biomarker sufficiently validated to rule out bacterial infection in the ED, there remains substantial interest in biomarkers representing various pathogenic pathways. New technologies for screening multiple genes and proteins are identifying unique network ‘signatures’ of clinical interest. Other future directions include rapid detection of bacterial DNA in blood, genes for antibiotic resistance and EMR‐based computational biomarkers that collate multiple information sources. Reliable, cost‐effective tests, validated in the ED to promptly and accurately identify sepsis, and to guide initial antibiotic choices, are important goals of current research efforts.