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International Study on Shock Severity Score (ISSS) - Enhancing Emergency Department Patient Outcomes

Investigating predictive scoring systems for better patient outcomes in shock at emergency departments in real-time. A multicenter, observational study approved by local ethics committees across six countries.

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International Study on Shock Severity Score (ISSS) - Enhancing Emergency Department Patient Outcomes

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  1. Grupo Español de Shock Prof. Dr. Ana Navío MD PhD Spanish National Director of Shock

  2. Grupo Español de Shock ALCALA, SCHOOL OF MEDICINE LA PAZ, HOSPITAL, MADRID

  3. Grupo Español de Shock

  4. Grupo Español de Shock

  5. Grupo Español de Shock

  6. Grupo Español de Shock

  7. 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.

  8. 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

  9. 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

  10. Grupo Español de Shock STUDY DESIGN I →PROSPECTIVE, →OBSERVACIONAL, →MULTICENTER , →INTERNATIONAL, →APPROVED BY THE LOCAL ETHICS COMMITEES

  11. Grupo Español de Shock COUNTRIES →ARGENTINA, →PARAGUAY, →COLOMBIA, →VENEZUELA, →MEXICO, →SPAIN

  12. 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

  13. 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

  14. Grupo Español de Shock STUDY SETTING • PATIENTS WERE ENROLLED AT SEVERAL : • URBAN, • TERTIARY, • WITH A CENSUS OF MORE THAN 100.000 ANUAL ED VISITS

  15. 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.

  16. Grupo Español de Shock METHODS • Data has beencollectedduring 3 monthsbytheinvestigators and held and analyzedbyanstatisticalteam in Madrid. • Number of patientsestimated: 3000

  17. 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%.

  18. Grupo Español de Shock ENROLLMENT WAS LIMITED TO PATIENTS WITH • EVIDENCE OF : • LACTIC ACIDOSIS, • SIGNS OF LOW PERFUSSION: • OLIGURIA< 30 CC/H, • CONSCIOUSNESS

  19. Grupo Español de Shock EXCLUSION CRITERIA INCLUDING • PREGNANT WOMAN, • NO PREFORM OF INCLUSION CRITERIA

  20. Grupo Español de Shock METHODS OF MEASUREMENT • A standardizedabstractionformwascreatedfor data collection. • Forbothemergencyteams, pre and in hospital departments.

  21. Grupo Español de Shock SCORE DEFINITIONS I

  22. Grupo Español de Shock SCORE DEFINITIONS II PRE-HOSPITAL

  23. Grupo Español de Shock • Number of data fields per patient were:25 • And as medicalinformation :

  24. Grupo Español de Shock • AGE • SEX: MALE/FEMALE • → CHRONICLE RENAL INSUFICIENCY • → CHRONICLE HEART FAILURE • →CHRONICLE BRONCHITIS • → CHRONICLE LIVER DISEASE

  25. Grupo Español de Shock • FIRST SHOCK INDEX (FC / TAS) • SOFA SCORE • KIND OF SHOCK • FIRST SUEROTHERAPY

  26. Grupo Español de Shock

  27. Grupo Español de Shock • TRANSFUSSION: WHAT/ DOSAGE • RED CELLS, PLAQUELETS, PLASMA • VASO PRESSOR DRUGS: WHICH /DOSAGE • CORTICOTHERAPY:WHICH/DOSAGE

  28. 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.

  29. Grupo Español de Shock

  30. Grupo Español de Shock

  31. Grupo Español de Shock THANK YOU FOR YOUR ATTENTION www.grupodeshock.org

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