title: Accuracy of oxygen tissue saturation values in assessing severity in patients with sepsis admitted to emergency departments.
abstract: BACKGROUND
  Near-infrared spectrometry assesses hemoglobin saturation of oxygen in tissues (StO2). Although it may provide additional information on local microcirculation function, the usefulness of near-infrared spectrometry in septic patients is debated. This study evaluated whether baseline StO2 value is useful in septic patients admitted to the emergency department with a diagnosis of severe sepsis.
  
  
  METHODS
  We carried out a prospective multicenter study in three emergency departments in Paris, France. Triage nurses were to record StO2, the results were blinding to the emergency physicians. Patients were eligible when presenting with at least two of the following parameters: temperature higher than 38°C or less than 36°C, respiratory rate greater than 30/min, heart rate greater than 120/min, and systolic arterial blood pressure less than 110 mmHg. Patients with a final diagnosis of sepsis and severe sepsis were analyzed.
  
  
  RESULTS
  We analyzed 98 patients (70 with sepsis and 28 with severe sepsis). Thirty-day mortality was 2.9 versus 14.3% (P=0.048) in the sepsis and the severe sepsis group, respectively. No significant difference in the median StO2 was observed in patients with sepsis and severe sepsis [79% (74-85%) vs. 77% (72-83%), respectively; P=0.66]. The area under the curve of the receiver operating characteristic curve for StO2 to predict severe sepsis was 0.53 (0.39-0.66; P=0.5) and the cutoff value was 77%. Median StO2 did not differ in patients admitted to the ICU [80% (60-88%) vs. 79% (74-84%); P=0.78] and in nonsurvivors compared with that of survivors [79% (74-85%) vs. 76% (73-83%); P=0.64].
  
  
  CONCLUSIONS
  This study fails to show any value of StO2 baseline at triage for early detection of severe sepsis in emergency patients.
authors.affiliation: aDepartment of Emergency Medicine and Surgery, Hospital Pitié-Salpétrière bDepartment of Emergency Medicine and Surgery, Hospital Tenon, Assistance Publique-Hôpitaux de Paris (APHP) cINSERM UMRS 956, 91 Boulevard de l'Hôpital, University Pierre et Marie Curie-Paris 6 (UPMC) dDepartment of Emergency Medicine, Hospital Cochin eDepartment of Emergency Medicine, Hospital Hôtel Dieu, APHP, University Paris Descartes, Paris fDepartment of Emergency Medicine, Hospital Princesse Grace, Monaco, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Goulet
authors.forename: Stéphanie
authors.initials: S
authors.lastname: André
authors.forename: Guillaume Der
authors.initials: GD
authors.lastname: Sahakian
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
authors.forename: Grégory
authors.initials: G
authors.lastname: Khelifi
authors.forename: Yann-Eric
authors.initials: YE
authors.lastname: Claessens
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000592:standards
chemical_list: D010100:Oxygen