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Grupo Español de Shock. Prof. Dr. Ana Navío MD PhD Spanish National Director of Shock. Grupo Español de Shock. ALCALA, SCHOOL OF MEDICINE. LA PAZ, HOSPITAL, MADRID. Grupo Español de Shock. Grupo Español de Shock. Grupo Español de Shock. Grupo Español de Shock. Grupo Español de Shock.
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Grupo Español de Shock Prof. Dr. Ana Navío MD PhD Spanish National Director of Shock
Grupo Español de Shock ALCALA, SCHOOL OF MEDICINE LA PAZ, HOSPITAL, MADRID
Grupo Español de Shock OBJECTIVES • THE AIM OF THIS STUDY IS TO TRY TO FIND THE SCORE FOR ASESSING THE OUTCOME OF PATIENTS WITH SHOCK AT THE EMERGENCY DEPARTMENTS, IN REAL TIME.
Grupo Español de Shock HISTORY I • PREVIOUS INVESTIGATIONS HAVE SHOWN THAT MOST OF THE SCORES POSSES, INADEQUATE PREDICTIVE ABILITIES TO ED POPULATION. • Jones AE, Fitch MT, KlineJA.Operational performance of validatedphisiologicscoringsystemsforpredicting in hospital mortalityamongcriticallyillemergencypatients. CritCareMed 2005; 33:974-978. • Jones AE, Saak K, Kline JA. Perfomance of themortality in emergencydepartmentsepsis score forpredicitng hospital mortalityamongpatientswithseveresepsis and septic shock. Am J EmergMed 2008, 25(6):689-692
Grupo Español de Shock HISTORY II • SCORING SYSTEMS HAVE BEEN EXPLORED IN THE ICU, • HOWEVER, RISK STRATIFICATION TOOLS ARE LESS COMMONLY USED IN ED. • Hargrove J, Nguyen HB,. Benchtobesidereview: outcomepredictionsforcriticallyillpatients in the ED. CritCare 2005; 9. 376-83
Grupo Español de Shock STUDY DESIGN I →PROSPECTIVE, →OBSERVACIONAL, →MULTICENTER , →INTERNATIONAL, →APPROVED BY THE LOCAL ETHICS COMMITEES
Grupo Español de Shock COUNTRIES →ARGENTINA, →PARAGUAY, →COLOMBIA, →VENEZUELA, →MEXICO, →SPAIN
Grupo Español de Shock STUDY DESIGN II • INTERNATIONAL COORDINATORS: • Dr. Gustavo Piñero ,MD, PhD. • Emergencyphisician at the Bahía Blanca “Dr. Leónidas Lucero” Hospital. • AssociateProfessor at theNationalUniversity of the South, Bahía Blanca • Argentina • gusrepi@speedy.com.ar
Grupo Español de Shock STUDY DESIGN II • INTERNATIONAL COORDINATORS: • Dra. Ana Navío ,MD, PhD. • Emergencyphisician at La Paz Hospital, Madrid , Spain. • AssociateProfessor at the Alcalá School of Medicine, Madrid • Spain • navio.ana@gmail.com
Grupo Español de Shock STUDY SETTING • PATIENTS WERE ENROLLED AT SEVERAL : • URBAN, • TERTIARY, • WITH A CENSUS OF MORE THAN 100.000 ANUAL ED VISITS
Grupo Español de Shock BACKGROUND • E.D. phisicians must be experts in the rapid recognition of the diagnosis and outcome of shock and the targeted intervention, to reduce morbidity , mortality and cost-efectivenes.
Grupo Español de Shock METHODS • Data has beencollectedduring 3 monthsbytheinvestigators and held and analyzedbyanstatisticalteam in Madrid. • Number of patientsestimated: 3000
Grupo Español de Shock ENROLLMENT WAS LIMITED TO PATIENTS WITH • PATIENTS WITH AGE BETWEEN 14-100 YEARS OLD • SBP< 110 mmHgorhypertensewith a fallingdown of more than 30%.
Grupo Español de Shock ENROLLMENT WAS LIMITED TO PATIENTS WITH • EVIDENCE OF : • LACTIC ACIDOSIS, • SIGNS OF LOW PERFUSSION: • OLIGURIA< 30 CC/H, • CONSCIOUSNESS
Grupo Español de Shock EXCLUSION CRITERIA INCLUDING • PREGNANT WOMAN, • NO PREFORM OF INCLUSION CRITERIA
Grupo Español de Shock METHODS OF MEASUREMENT • A standardizedabstractionformwascreatedfor data collection. • Forbothemergencyteams, pre and in hospital departments.
Grupo Español de Shock SCORE DEFINITIONS I
Grupo Español de Shock SCORE DEFINITIONS II PRE-HOSPITAL
Grupo Español de Shock • Number of data fields per patient were:25 • And as medicalinformation :
Grupo Español de Shock • AGE • SEX: MALE/FEMALE • → CHRONICLE RENAL INSUFICIENCY • → CHRONICLE HEART FAILURE • →CHRONICLE BRONCHITIS • → CHRONICLE LIVER DISEASE
Grupo Español de Shock • FIRST SHOCK INDEX (FC / TAS) • SOFA SCORE • KIND OF SHOCK • FIRST SUEROTHERAPY
Grupo Español de Shock • TRANSFUSSION: WHAT/ DOSAGE • RED CELLS, PLAQUELETS, PLASMA • VASO PRESSOR DRUGS: WHICH /DOSAGE • CORTICOTHERAPY:WHICH/DOSAGE
Grupo Español de Shock • Weknow, howearlywemustidentifythepatient in shock, butwe do notknow , as well, theseverityduringtheevolution and themeasurable improvements in mortality and morbidity rates,as an answer of ourtherapy. • Theresults of the ISSS study, perhaps, willhelpustofindtheanswers.
Grupo Español de Shock THANK YOU FOR YOUR ATTENTION www.grupodeshock.org