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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
    Griffith University Author(s)
    Keijzers, Gerben
    Fraser, John F.
    Year published
    2018
    Metadata
    Show full item record
    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, ...
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    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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    Journal Title
    Emergency Medicine Australasia
    Volume
    30
    Issue
    1
    DOI
    https://doi.org/10.1111/1742-6723.12924
    Subject
    Clinical sciences
    Clinical sciences not elsewhere classified
    Health services and systems
    Public health
    Publication URI
    http://hdl.handle.net/10072/381055
    Collection
    • Journal articles

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