Septic Shock Diagnosis - Medical Algorithm

Description

Spronck et al developed a score for the diagnosis of shock in a patient with septic shock based on a number of clinical and laboratory findings.

Parameters:

(1) hemodynamic state

(2) peripheral circulation

(3) microvascular variables

(4) systemic markers of tissue oxygenation

(5) signs of organ dysfunction

Hemodynamic Parameter	Finding	Points
heart rate	<= 100 beats per minute	0
	> 100 beats per minute	2
mean arterial pressure (MAP) and central venous pressure (CVP)	MAP >= 50 mm Hg	0
	MAP < 50 mm Hg AND CVP (< 2 mm Hg OR > 15 mm Hg)	2
	MAP < 50 mm Hg AND CVP (2-15 mm Hg)	2
cardiac index	>= 2.2 L per min per square meter BSA	0
	< 2.2 L per min per square meter BSA	2

mean arterial pressure in mm Hg =

= ((systolic blood pressure) + (2 * (diastolic blood pressure))) / 3

Peripheral Circulation Parameter	Finding	Points
skin	not mottled	0
	mottled	2
difference in temperature between central core and peripheral toe	<= 5°C	0
	> 5°C	2
peripheral perfusion index	>= 0.3	0
	< 0.3	2
peripheral capillary refill	normal or slight decrease	0
	impaired	2

difference in temperature between central core and peripheral toe =

= (core temperature in °C) - (temperature at toe in °C)

Microvascular Parameter	Finding	Points
tonometric CO2 gap	normal or decreased	0
	increased	1
sublingual CO2 gap	normal or decreased	0
	increased	1
sublingual microvascular perfusion	normal	0
	impaired	1

Tissue Oxygenation Parameter	Finding	Points
serum lactate	<= 4 mmol/L	0
	> 4 mmol/L	1
oxygen saturation in mixed venous blood	>= 60%	0
	< 60%	1

Organ Dysfunction Parameter	Finding	Points
diuresis related to present disease	no change or >= 0.5 mL per kg per hour	0
	< 0.5 mL per kg per hour	1
mental status related to present disease	no change from baseline	0
	decreased	1

total score =

= MAX(points for hemodynamic state) + MAX(points for peripheral circulation) + MAX(points for microvascular variables) + MAX(points for systemic markers for oxygenation) + (points for urine output) + (points for mental status)

Interpretation:

• minimum score: 0

• maximum score: 8

• A score > 2 indicates the presence of shock.

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Description

Specialty

Objective

ICD-10

Integrative Clinical Score of Spronk et al for the Diagnosis of Shock in a Patient with Septic Shock

Purpose: To evaluate a septic patient for shock using the clinical score of Spronk et al.

Description

Specialty

Objective

ICD-10