The Epidemiology and Approach to Differentiating Etiologies of Shock in the Emergency Department
Study Details
Study Description
Brief Summary
The Shock Tool study is designed to improve the clinical evaluation for differentiating shock in the emergency department. The goal of this study is to evaluate and improve the accuracy of physicians differentiating causes of shock.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Specific Aim #1: To study the epidemiology of shock in the emergency department Hypothesis 1:
We will better understand shock states if we determine shock etiology among patients presenting to the emergency department in a carefully conducted observational prospective study.
Specific Aim #2: To determine the accuracy of physician diagnosis for the underlying etiology of shock.
Hypothesis 2: Physician assessment of the underlying cause of shock is challenging and often inaccurate in the early stages of care in the emergency department.
Specific Aim #3: To optimize the evidence-based approach to assist in the diagnosis of shock etiology from elements readily available when a patient demonstrates shock physiology in the Emergency Department.
Hypothesis 3: An evidenced-based, standardized approach to clinical decision making integrating elements of the history, physical exam, and early testing will improve a physician's ability to accurately differentiate etiologies of shock.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Shock Patients found to have persistent hypotension after resuscitation or vasopressor requirement |
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| Pre-shock Patients with markedly abnormal vital signs (Heart Rate (HR)>130, Respiratory Rate (RR)>24, Shock Index >1, Lactate > 4.0mmol/L, or Systolic Blood Pressure (SBP) <90mm/hg) without shock, as defined previously. |
Outcome Measures
Primary Outcome Measures
- Etiology of Shock [Retrospectively, 1 month after enrollment]
Each patient determined to have shock in the emergency department is given a single diagnosis by a reviewing physician after the hospital course is completed.
Secondary Outcome Measures
- In hospital mortality [This measure will be assessed at the time of physician review after discharge from hospital, on average 2 months after initial ED visit.]
Death by any cause during hospitalization
Other Outcome Measures
- Deterioration [This measure will be assessed at the time of physician review after discharge from hospital, on average 2 months after initial ED visit.]
A composite outcome met if any of the following are present during hospitalization: acute renal failure (creatinine 2x baseline or new initiation of dialysis), non-elective intubation, vasopressor requirement, or mortality.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age 18 years or great
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For pre-shock cohort: HR > 130, RR>24, Shock index > 1, lactate > 4.0mmol/L, SBP < 90mm/hg)
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For shock cohort: persistent blood pressure <90mm/hg after resuscitation
Exclusion Criteria:
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seizure
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isolated atrial fibrillation with discharge after rate control achieved
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discharged from the emergency department
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intoxication or withdrawal
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Beth Israel Deaconess Medical Center
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2012P-000357