Review article: Sepsis in the emergency department – Part 2: Investigations and monitoring |
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| Authors: | Amith Shetty Stephen PJ Macdonald Gerben Keijzers Julian M Williams Benjamin Tang Bas de Groot Kelly Thompson John F Fraser Simon Finfer Rinaldo Bellomo Jonathan Iredell |
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| Affiliation: | 1. Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia;2. Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia;3. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia;4. Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia;5. Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia;6. School of Medicine, Bond University, Gold Coast, Queensland, Australia;7. School of Medicine, Griffith University, Gold Coast, Queensland, Australia;8. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia;9. Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia;10. Immunology Department, Westmead Millennium Institute for Medical Research, Sydney, New South Wales, Australia;11. Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia;12. Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands;13. Critical Care and Trauma Division, George Institute for Global Health, Sydney, New South Wales, Australia;14. Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia;15. Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia;16. Division of Critical Care, George Institute for Global Health, Sydney, New South Wales, Australia;17. Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia;18. School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia;19. Infectious Diseases, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia;20. Institute of Clinical Pathology and Medical Research, Pathology West, Sydney, New South Wales, Australia |
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| Abstract: | ![]()
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. |
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| Keywords: | diagnostic techniques and procedures forecasting mass screening monitoring physiologic sepsis |
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