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. 2024 Oct 27;28(1):346.
doi: 10.1186/s13054-024-05141-5.

Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

Marta Cancella de Abreu  1   2 , Timothé Sala  3 , Enfel Houas  3 , Ilaria Cherubini  3 , Martin Larsen  4 , Pierre Hausfater  3   5
Affiliations

Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study

Marta Cancella de Abreu et al. Crit Care. .

Abstract

Background: Timely recognition of sepsis in emergency department (ED) is challenging. We evaluated the impact of implementing the biomarker monocyte distribution width (MDW) at bedside, on the time to anti-infective administration.

Methods: We conducted a before-and-after cohort study in the ED of an academic hospital in Paris, to compare sepsis patients care and outcomes, before and after the implementation of point of care (POC) MDW measurement in the ED. During post-implementation period (period-2), MDW was measured with complete blood count by ED nurses with results given in 2 min: if above 21.5 units, ED physicians were asked to consider sepsis and to start an anti-infectious as soon as possible. Primary endpoint was time to anti-infectious administration (TTA) from ED arrival, and secondary endpoints were TTA from sepsis onset (TTAS), length of stay, mortality, and hospitalization rates.

Results: In total, 255 patients (period-1) and 180 patients (period-2) with sepsis were included. The TTA was 5.4 h (3.5-7.7) period-1 and 4.9 h (IQR 2.5-7.1) in period-2 (p = 0.06). MDW implementation significantly reduced the median TTAS from to 3.7 h (IQR 1.5-5.8) in period-1, to 2.2 h (IQR 0.5-4.5) in period-2 (p < 0.001). Mortality rates remained similar between the two periods (18% vs. 16% respectively, p = 0.4), as did hospitalization rates (93% vs. 91%, p = 0.4) and ED length of stay (7.2 h (5.3-9.8) vs 7.0 (5.4-9.4), p = 0.7).

Conclusion: Implementing POC MDW measurement in the ED protocols enhances the timeliness of anti-infective administration from sepsis onset, meeting current sepsis management guidelines.

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Conflict of interest statement

MCA, TS, EH, IC and ML have no competing interest. PH—received consultant fees and lecture honorarium from Beckman Coulter.

Figures

Fig. 1
Fig. 1
Flowchart for sepsis-patient’s selection procedure. CBC cell blood count. ED emergency department
See this image and copyright information in PMC

References

    1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensiv Care Med. 2021;47(11):1181–247. - PMC - PubMed
    1. Le Conte P, Thibergien S, Obellianne JB, Montassier E, Potel G, Roy PM, et al. Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals. BMC Emerg Med. 2017;17(1):27. - PMC - PubMed
    1. Filbin MR, Thorsen JE, Lynch J, Gillingham TD, Pasakarnis CL, Capp R, et al. Challenges and opportunities for Emergency Department sepsis screening at triage. Sci Rep. 2018;8(1):11059. - PMC - PubMed
    1. Litell JM, Guirgis F, Driver B, Jones AE, Puskarich MA. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Acad Emerg Med. 2021;28(7):745–52. - PMC - PubMed
    1. Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med. 2019;37(8):1490–7. - PubMed

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