The prehospital SIGARC score to assess septic shock in-hospital, 30-day and 90-day mortality

Romain Jouffroy; Basile Gilbert; Jean Pierre Tourtier; Emmanuel Bloch-Laine; Patrick Ecollan; Vincent Bounes; Josiane Boularan; Papa Gueye-Ngalgou; Benoît Vivien

doi:10.1016/j.ajem.2020.10.014

The prehospital SIGARC score to assess septic shock in-hospital, 30-day and 90-day mortality

Am J Emerg Med. 2021 Aug:46:355-360. doi: 10.1016/j.ajem.2020.10.014. Epub 2020 Oct 8.

Authors

Romain Jouffroy¹, Basile Gilbert², Jean Pierre Tourtier³, Emmanuel Bloch-Laine⁴, Patrick Ecollan⁵, Vincent Bounes², Josiane Boularan⁶, Papa Gueye-Ngalgou⁷, Benoît Vivien⁸

Affiliations

¹ Intensive Care Unit, Anaesthesiology, SAMU, Necker - Enfants Malades Hospital, AP-HP Centre, Université de Paris, Paris, France; Paris Fire Brigade Emergency Medical Service, Paris, France; Intensive Care Unit, Ambroise Paré Hospital, AP-HP, Université Paris Saclay, Boulogne Billancourt, France. Electronic address: romain.jouffroy@aphp.fr.
² Department of Emergency Medicine, SAMU 31, University Hospital of Toulouse, Toulouse, France.
³ Paris Fire Brigade Emergency Medical Service, Paris, France.
⁴ Emergency Department, Cochin Hospital, Paris, France & Emergency Department, SMUR, Hôtel Dieu Hospital, Paris, France.
⁵ Intensive Care Unit, SMUR, Pitié Salpêtriere Hospital, Sorbonne Université, Paris, France.
⁶ SAMU 31, Castres Hospital, Castres, France.
⁷ SAMU 972 CHU de Martinique Pierre Zobda -Quitman Hospital, Fort-de-France, Martinique, France.
⁸ Intensive Care Unit, Anaesthesiology, SAMU, Necker - Enfants Malades Hospital, AP-HP Centre, Université de Paris, Paris, France.

PMID: 34348435
DOI: 10.1016/j.ajem.2020.10.014

Abstract

Background: In the pre-hospital setting the early identification of septic shock (SS) patients presenting with a high risk of poor outcome remains a daily challenge. The development of a simple score to quickly identify these patients is essential to optimize triage towards the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the new SIGARC score and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU).

Methods: SS patients cared for by a MICU between 2017, April 15th, and 2019, December 1st were included in this retrospective study. The SIGARC score consists of the addition of 5 following items (1 point for each one): shock index≥1, Glasgow coma scale<13, age > 65, respiratory rate > 22 and comorbidity defined by the presence of at least 2 underlying conditions among: hypertension, coronaropathy, chronic cardiac failure, chronic renal failure, chronic obstructive pulmonary disease, diabetes mellitus, history of cancer and human immunodeficiency virus infection. A threshold of SIGARC score ≥ 2 was arbitrarily chosen to define severity for its usefulness in clinical practice.

Results: Data from 406 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 71 ± 15 years and 268 of the patients (66%) were male. The presumed origin of SS was pulmonary (42%), digestive (25%) or urinary (17%) infection. Overall in-hospital mortality was 31% with, 30 and 90-day mortality was respectively 28% and 33%. A prehospital SIGARC score ≥ 2 is associated with an increase in 30 and 90-day mortality with HR = 1.57 [1.02-2.42] and 1.82 [1.21-2.72], respectively.

Conclusion: A SIGARC score ≥ 2 is associated with an increase in in-hospital, 30 and 90-day mortality of SS patients cared for by a MICU in the prehospital setting. These observational results need to be confirmed by prospective studies.

Keywords: Assessment; Outcome; Prehospital setting; Septic shock; Severity; Triage.

MeSH terms

Aged
Early Warning Score*
Emergency Medical Services*
Female
France / epidemiology
Hospital Mortality*
Humans
Male
Predictive Value of Tests
Retrospective Studies
Shock, Septic / diagnosis*
Shock, Septic / mortality*
Shock, Septic / therapy