Biomarkers and Molecular Diagnostics for Early Detection and Targeted Management of Sepsis and Septic Shock in the Emergency Department.

Abstract

Sepsis and septic shock are true medical emergencies responsible for >1.5 million hospitalizations and 250000 deaths in the US each year (1). Emergency care practitioners recognize that reduction of morbidity and mortality from sepsis is directly dependent on early identification and rapid initiation of therapy, which includes fluid resuscitation and antimicrobial therapy. In the US the initial evaluation for most septic patients, including those admitted to the intensive care unit, occurs in emergency department (ED)3 settings (2). As such, emergency physicians work on the front line of sepsis care, frequently making critical diagnostic and therapeutic decisions that profoundly affect overall care trajectory and patient outcomes. The continuum of sepsis care delivered in the ED can be divided into 2 domains: ( a ) detection and diagnosis and ( b ) treatment initiation and ongoing evaluation coupled with resuscitation. Decision-making within each of these domains is complicated by the uniquely challenging practice environment of the ED, where a wide variety of acute and undifferentiated diseases are managed, typically with limited information and always under intensive time pressure. Despite extensive research efforts over the past decade, there has been relatively little increase in the amount of objective data available to emergency physicians during …