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 FERNANDO ABAD ESTEBAN SIRA AGUILÓ MIR SUMMA 112 Hospital Clinic, Barcelona 2 ELENA ALVARO JAÚREGUI H. La Fe , Valencia 3 JOSE EMILIO ALONSO LASHERAS HU, Tenerife 4 DANIEL AFONSO RIVERO H. La Princesa, Madrid 5 Mª ANGELES ARAGÓN LEAL H. de Jerez, Cádiz 6 MAITE AYUSO ARAGONÉS H. La Paz , Madrid 7 VANESA BLASCO FRAILE H. La Paz , Madrid 8 CONSUELO CANENCIA HERNÁNDEZ SAMUR Ayto Madrid 9 JUAN CAÑERO CRIADO H.Virgen de Victoria , Málaga 10 JUAN CARLOS COBO BARQUIN Hospital Central, Asturias 11 MANUEL CUESTA MARTÍN H. Cruces, Bilbao 12 SONIA FERNANDEZ-ARRUTY FERRO Hospital U. de Santiago, Coruña 13 VANESA GALLEGO VILLALVILLA H.12 de Octubre, Madrid 1 Grupo Español de Shock JOSE CARLOS GARCÍA CARAVACA H. Morales Meseguer, Murcia CARMEN GARGALLO MAICAS H. La Fe, Valencia ISABEL GIL ROSA H. Reina Sofía, Murcia ELENA GOMEZ DEL PULGAR CARRILLO H. La Paz, Madrid ELBA GONZALEZ DE LINARES H. Marqués de Valdecilla, Santander PABLO GUALLAR SOLA Fundación Hospital de Calahorra, Zaragoza, La Rioja ROCIO JIMENEZ GÓMEZ Hospital U.de Puerto Real, Cádiz AMAIA IBARRA BOLT Hospital Virgen del Camino, Navarra VICTOR MARQUINA ARRIBAS H.G. Alicante ESTHER MARTÍNEZ LARRUL H. Gregorio Marañón, Madrid GUILLERMO MURILLO PUTZE Complejo Hospitalario U.de Canarias ANA NAVÍO SERRANO H. , Madrid OSCAR ORTIGOSA AGUSTÍN H Miguel Servet, Zaragoza GERARDO PALACIOS MARÍN Fundación Hospital de Calahorra ,La Rioja Grupo Español de Shock FELIPE PASCUAL CLEMENTE H. Ramón y Cajal, Madrid ERNESTO PERALES PIQUERES H G Cáceres RAMÓN PERALES PARDO UCH Albacete AITANA PEREZ FENANDEZ Fundación Hospital de Calahorra ,La Rioja VERONICA REINA LORA H.Puerta del Mar, Cádiz FRANCISCO DE BORJA QUERO ESPINOSA H Reina Sofía, Córdoba MICHEL RIESCO GARCÍA H.U. de Salamanca ALEJANDRO RODRIGUEZ CAMACHO Hospital Puerta del Mar, Cádiz ANTONIO ROJAS RAMIREZ H. Osuna ,Sevilla. FRANCISCO JAVIER RUBIO ALONSO H Son Llazter, Mallorca FRANCISCO JAVIER RUIZ CASTILLA Hospital de Jerez, Cádiz ANA SAGARRA LOZANO H.Puerta del Mar, Cádiz CRISTINA MARTIN DOMINGUEZ H. S. Pedro de Alcantara, Cáceres Grupo Español de Shock FUENSANTA SORIANO RODRIGUEZ Hospital Infanta Margarita de Cabra JUAN SINISTERRA AQUILINO S.E.S. Alicante JOSE MANUEL TORRES MURILLO H Reina Sofía, Córdoba JOSE MANUEL VALLES TARAZONA H. La Fe, Valencia (Córdoba). 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, Kline JA.Operational performance of validated phisiologic scoring systems for predicting in hospital mortality among critically ill emergency patients. Crit Care Med 2005; 33:974-978. Jones AE, Saak K, Kline JA. Perfomance of the mortality in emergency department sepsis score for predicitng hospital mortality among patients with severe sepsis and septic shock. Am J Emerg Med 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,. Bench to beside review: outcome critically ill patients in the ED. Crit Care 2005; 9. 376-83 predictions for 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. Emergency phisician at the Bahía Blanca “Dr. Leónidas Lucero” Hospital. Associate Professor at the National University of the South, Bahía Blanca Argentina gusrepi@speedy.com.ar Grupo Español de Shock STUDY DESIGN II INTERNATIONAL COORDINATORS: Dra. Ana Navío ,MD, PhD. Emergency phisician at La Paz Hospital, Madrid , Spain. Associate Professor 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 costefectivenes. Grupo Español de Shock METHODS Data has been collected during 3 months by the investigators and held and analyzed by an statistical team in Madrid. Number of patients estimated : 3000 Grupo Español de Shock ENROLLMENT WAS LIMITED TO PATIENTS WITH PATIENTS WITH AGE BETWEEN 14100 YEARS OLD SBP< 110 mmHg or hypertense with a falling down 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 E XC LU S I O N C R I T E R I A I N C LU D I N G PREGNANT WOMAN, NO PREFORM OF CRITERIA INCLUSION Grupo Español de Shock METHODS OF MEASUREMENT A standardized abstraction form was created for data collection. For both emergency teams, pre and in hospital departments . Grupo Español de Shock SCORE DEFINITIONS I MEASUREMENTS TIME DELAY IN FILLED CAPILLARY sg BSP mmHg VENOUS OXYGEN SATURATION 0 1 2 3 0h <2 3-4,5 4,6-5 >5 >110 71 85 101-109 61 - 70 91-100 51 - 60 >90 < 50 o > 85 NEGATIVE BASE EXCESS LACIDEMIA (mMol /l) <3 4-9 10 - 14 < - 15 <1 1,1 – 2 2,1 – 4 >4 ARTERIAL PRESSURE FiO2 RCP(mg/l) > 300 201 - 299 < 200 <5 6 - 50 199 200 51 - 100 PROCALCITONIN <0,1 0,1-0,25 0,260,50 >0,5 PRO- ADM FROM 0 TO 24 POINTS > 100 6h 24 h Grupo Español de Shock SCORE DEFINITIONS II MEASUREMENTS 0 1 2 3 TIME 0h DELAY IN FILLED CAPILLARY sg SBP mmHg <2 3-4,5 4,6-5 >5 >110 101-109 91-100 >90 DBP mmHg >80 70-79 69-60 <59 HEART BEAT ppm >100 90-99 80-89 <80 RESPIRATORY RATE rpm >40 30-39 20-29 <20 PERIPHERAL OXYGEN SATURATION % 71 – 90 61 - 70 51 - 60 < 50 o > 85 PRE-HOSPITAL Grupo Español de Shock Number of data fields per patient were:25 And as medical information : 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 Grupo Español de Shock TRANSFUSSION: WHAT/ DOSAGE RED CELLS, PLAQUELETS, PLASMA VASO PRESSOR DRUGS: WHICH /DOSAGE CORTICOTHERAPY : WHICH/DOSAGE Grupo Español de Shock We know, how early we must identify the patient in shock, but we do not know , as well, the severity during the evolution and the measurable improvements in mortality and morbidity rates, as an answer of our therapy. The results of the ISSS study, perhaps, will help us to find the answers. Grupo Español de Shock Grupo Español de Shock Grupo Español de Shock ww w. g r u p o d e s h o c k . o r g