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OBJECTIVES:. Exploiting the complete blood count (CBC) with differential (CBC-diff) for early sepsis detection has practical value for emergency department (ED) care, especially for those without obvious presentations. The objective of this study was to develop the CBC Sepsis Index (CBC-SI) that incorporates monocyte distribution width (MDW) to enhance rapid sepsis screening. DESIGN:. A retrospective observational study. SETTING:. The ED of the University of Kansas Medical Center, United States. PATIENTS:. All adult patients (age 18 or over) presenting to the ED between August 8, 2020, and April 1, 2022, that received a CBC-diff as part of routine clinical care. INTERVENTIONS:. MDW, WBC count, and neutrophil-to-lymphocyte ratio were used to develop a CBC-SI (0 low to 5 high risk) for early sepsis detection. The diagnostic performance of CBC-SI was evaluated for patients with and without obvious early signs of sepsis. MEASUREMENTS AND MAIN RESULTS:. In a cohort of 51,407 ED visits, 1,683 (3.3%) met sepsis criteria; 1,343 (79.8%) septic patients presented with obvious signs and 340 (20.2%) without. The overall area under the curve of the CBC-SI was 0.83 (95% CI, 0.81–0.85). A CBC-SI of greater than or equal to 1 point exhibited a sensitivity of 83.1% (95% CI, 79.9–86.2%) and specificity of 64.8% (95% CI, 64.0–65.5%). Superior performance was observed in the patient subgroup presenting without obvious signs; greater than or equal to 1 point, 81.1% (95% CI, 73.2–88.9%) sensitivity and 69.1% (95% CI, 68.3–69.9%) specificity. Septic patients without obvious signs exhibited delays in antibiotic administration from arrival (median 4.7 vs. 3.4 hr; p < 0.001) and higher rates of ICU admission (43.8% vs. 27.9%; p < 0.001) and in-hospital mortality (14.7% vs. 9.8%; p = 0.011) compared with the septic subgroup presenting with obvious signs. CONCLUSIONS:. The CBC-SI demonstrated strong performance for early sepsis detection. Its performance was best for nonobvious presentations, suggesting highest utility in a subgroup that is most susceptible to delayed interventions and poorer outcomes.

Abstract Sepsis impacts 1.7 million Americans annually. It is a life‐threatening disruption of organ function because of the body's host response to infection. Sepsis remains a condition frequently encountered in emergency departments (ED) with an estimated 850,000 annual visits affected by sepsis each year in the United States. The pillars of managing sepsis remain timely identification, initiation of antimicrobials while aiming for source control and resuscitation with a goal of restoring tissue perfusion. The focus herein is current evidence and best practice recommendations for state‐of‐the‐art sepsis care that begins in the ED.

Abstract Objectives Cocaine use (CU) related chest pain (CP) is a common cause of emergency department (ED) visits in the United States. However, information on disposition and outcomes in these patients is scarce. We conducted a nationwide study to assess disposition from ED, hospitalization rates, in‐hospital outcomes, and health care costs in patients with history of CU who presented to the ED with CP. Methods We queried the Nationwide Emergency Department Sample database from 2016–2018 for adult patients with CU presenting to the ED with CP. International Classification of Diseases, Tenth Revision codes were used to identify study patients. Results We identified 149,372 patients. The majority were male (76%), presented to metropolitan centers (91.3%), and had a high prevalence of cardiovascular risk factors (48.1% with hypertension, 24.4% with coronary artery disease, 18.2% with diabetes) and psychiatric illnesses (21%). Overall, 21.4% of patients were hospitalized, 68.6% were discharged from ED and 6.6% left against medical advice. Patients requiring admission were older (51.8 vs 45.0; P

Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that “mild” forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.