Procalcitonin and NEWS2 evaluation for Timely identification of Sepsis and Optimal use of antibiotics in the Emergency Department
Sponsor: University of Liverpool
CI: Prof Neil French
Approval Date: 08 December 2020
Sepsis is a common, potentially life-threatening complication of infection. The optimal treatment for sepsis includes early recognition, prompt antibiotics and fluids into a vein (intravenous/IV). Currently, clinicians assess severity in patients in the Emergency Department with a scoring system based on simple to measure observations: the National Early Warning Score (NEWS2). NEWS2 helps clinicians identify the sickest patients. It is not specific and tends to over-diagnose sepsis leading to over prescribing of antibiotics and promoting antimicrobial resistance. It is the best we have and currently used in over 70% of English hospitals. Adults with suspected sepsis fall into one of three categories: a) those looking ill needing urgent IV antibiotics and fluids within 1 hour, b) those that are unwell, but will not come to harm if IV antibiotics are not administered within 1 hour, allowing time for further assessment prior to starting antibiotics within 3 hours, c) those not critically unwell who may or may not need IV antibiotics. Procalcitonin (PCT), a blood test not widely used in the NHS, helps to identify bacterial infection. The National Institute for Health and Care Excellence (NICE) recommended further research on PCT testing in emergency departments for guiding antibiotic use in people with suspected sepsis. PRONTO is a study funded by the National Institute for Health Research (NIHR) run by University of Liverpool and Cardiff trials unit looking to improve assessment of patients with suspected sepsis in the emergency department using a 20 minute test. We want to reduce the amount of unnecessary broad spectrum antibiotics used with a minimum of no change in mortality.
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