The Epidemiology and Approach to Differentiating Etiologies of Shock in the Emergency Department

Study Overview
=================
Brief Summary
-----------------
The Shock Tool study is designed to improve the clinical evaluation for differentiating shock in the emergency department. The goal of this study is to evaluate and improve the accuracy of physicians differentiating causes of shock.

Detailed Description
-----------------
Specific Aim #1: To study the epidemiology of shock in the emergency department Hypothesis 1: We will better understand shock states if we determine shock etiology among patients presenting to the emergency department in a carefully conducted observational prospective study. Specific Aim #2: To determine the accuracy of physician diagnosis for the underlying etiology of shock. Hypothesis 2: Physician assessment of the underlying cause of shock is challenging and often inaccurate in the early stages of care in the emergency department. Specific Aim #3: To optimize the evidence-based approach to assist in the diagnosis of shock etiology from elements readily available when a patient demonstrates shock physiology in the Emergency Department. Hypothesis 3: An evidenced-based, standardized approach to clinical decision making integrating elements of the history, physical exam, and early testing will improve a physician's ability to accurately differentiate etiologies of shock.

Official Title
-----------------
Establishing a Tool to Increase the Accuracy of Emergency Physicians Diagnosing Etiologies of Shock

Conditions
-----------------
Undifferentiated Shock

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age 18 years or great For pre-shock cohort: HR > 130, RR>24, Shock index > 1, lactate > 4.0mmol/L, SBP < 90mm/hg) For shock cohort: persistent blood pressure <90mm/hg after resuscitation Exclusion Criteria: seizure isolated atrial fibrillation with discharge after rate control achieved discharged from the emergency department intoxication or withdrawal

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Shock<br>Patients found to have persistent hypotension after resuscitation or vasopressor requirement | |
| Pre-shock<br>Patients with markedly abnormal vital signs (Heart Rate (HR)>130, Respiratory Rate (RR)>24, Shock Index >1, Lactate > 4.0mmol/L, or Systolic Blood Pressure (SBP) <90mm/hg) without shock, as defined previously. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Etiology of Shock | Each patient determined to have shock in the emergency department is given a single diagnosis by a reviewing physician after the hospital course is completed. | Retrospectively, 1 month after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In hospital mortality | Death by any cause during hospitalization | This measure will be assessed at the time of physician review after discharge from hospital, on average 2 months after initial ED visit. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Shock, Predicting diagnosis, Predicting adverse outcomes