Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/17363
Title: Review article: Sepsis in the emergency department - Part 2: Investigations and monitoring.
Authors: 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
Affiliation: Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia
Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
School of Medicine, Bond University, Gold Coast, Queensland, Australia
School of Medicine, Griffith University, Gold Coast, Queensland, Australia
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
Immunology Department, Westmead Millennium Institute for Medical Research, Sydney, New South Wales, Australia
Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands
Critical Care and Trauma Division, George Institute for Global Health, Sydney, New South Wales, Australia
Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
Division of Critical Care, George Institute for Global Health, Sydney, New South Wales, Australia
Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
Infectious Diseases, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia
Institute of Clinical Pathology and Medical Research, Pathology West, Sydney, New South Wales, Australia
Issue Date: Feb-2018
EDate: 2018-01-16
Citation: Emergency medicine Australasia : EMA 2018; 30(1): 4-12
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.
URI: http://ahro.austin.org.au/austinjspui/handle/1/17363
DOI: 10.1111/1742-6723.12924
ORCID: 0000-0001-7349-1128
0000-0001-9921-4620
0000-0003-1100-4552
0000-0002-1650-8939
PubMed URL: 29341498
Type: Journal Article
Review
Subjects: diagnostic techniques and procedures
forecasting
mass screening
monitoring physiologic
sepsis
Appears in Collections:Journal articles

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