الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis and septic shock are important healthcare issues that impact millions of individuals worldwide each year, killing up to one in every four. Sepsis is one of the major health conditions that is becoming more prevalent in the emergency room (ED). It is usually seen in the ED as emergency cases arrive here first.
Since 1992, the definition of sepsis has evolved multiple times. The Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) published updated definition and clinical criteria for sepsis and septic shock in 2016. (SEP-3). Sepsis is described as ”life-threatening organ dysfunction induced by a dysregulated host response to infection” and is clinically assessed using the sequential organ failure assessment (SOFA) score. The Sequential (Sepsis-related) Organ Failure Assessment Scoring system is used to assess organ dysfunction in the Sepsis-3 definition of sepsis (SOFA).
Organ dysfunction for the Sepsis-3 definition for sepsis is measured clinically with the Sequential (Sepsis-related) Organ Failure Assessment Score (SOFA). An acute increase in a SOFA score of ≥2 indicates sepsis as explained by the most recent 2016 sepsis definitions.
Sepsis is a time sensitive diagnosis such as polytrauma, acute myocardial infarction, or stroke patients. Delay in identification and appropriate management of septic patients in the initial hours results in poor outcomes and increases the mortality. As a result, early and accurate detection of sepsis is critical for initiating treatment such as antibiotic medication and hemodynamic cardiac output optimization, which will undoubtedly result in a better prognosis.
The high morbidity, mortality of sepsis and economic burden of treating septic patients in emergency department not only represent the main problem statement in the emergency department but also, there is no a single symptom, sign or marker that could differentiate between the presence of infection and sepsis.
The qSOFA criteria (quick SOFA) give easy bedside criteria for identifying adult patients with probable infection who are at risk of sepsis. The qSOFA consists of three variables: (a) a RR greater than or equal to 22 breaths per minute, (b) altered mentation, and (c) SBP ≤100 mmHg. Many studies showed that qSOFA has poor sensitivity for identification of Sepsis and Septic Shock. Therefore, identifying early, new accessible parameters for early sepsis diagnosis in emergency department is desirable.
A reliable and valid tool that does not require much time, and is simple to use, with a high sensitivity and specificity, is needed for use at triage in EDs to accurately identify individuals with sepsis and septic shock. Therefore, the aim of the current work was to evaluate the predictive performance of systemic symptoms of infection, vital signs, qSOFA and initial laboratory values (CBC, CRP, and lactate level) for early detection and diagnosis of sepsis in initial emergency department visit of patients with history of infection and to create a new model that could be used as a screening tool of sepsis in emergency department.
The present study was conducted on 250 adult non-trauma patients receiving medical service in the AMUH emergency department. Study subjects selected for this study were evaluated to have suspected source of infection or other factors that might increase the risk of sepsis under specific inclusion criteria. Pregnant and post cardiac arrest patient were excluded from the study subjects.