SOFA scoring

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The SOFA score (Sepsis-related organ failure assessment score) assesses organ failure in ICU patients. It is relevant to us because it can be part of the definition of Severe sepsis

For more info see https://en.wikipedia.org/wiki/SOFA_score

Components

Category 0 1 2 3 4
GCS 15 13-14 10-12 6-9 <6
Platelets >=150 <150 <100 <50 <20
Serum bilirubin (uM) <20 20-32 33-101 102-204 >204
Serum creatinine (uM) <110 110-170 171-299 300-440 >440
Urine output (mL/day) <500 <200
PaO2/FIO2 >=400 <400 <300 <200 <100
Cardiovascular MAP>=70 MAP<70 see note A see note B see note C
  • Note A: dopamine < 5 OR any dose of dobutamine
  • Note B: dopamine 5.1-15 OR epi<=0.1 OR norepi<=0.1
  • Note C: dopamine >15 OR epi>0.1 OR norepi>0.1
  • for these all doses are in microgram/kg/min
  • Need to clarify vasopressors in the guideline. Should we include vasopressin, epinephrine, phenylephrine? --LKolesar 09:06, 2018 February 23 (CST)
  • Also in some sepsis cases, Dobutamine and Milrinone are use if the patient has a reduced cardiac output and needs inotropic support. --LKolesar 09:06, 2018 February 23 (CST)

Discussion - Is it feasible to use in our data collection setting?

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Z) decided to revisit 6 months after ICD10

  • SMW


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  • Categories

SOFA SCORE feasibility of use in coding sepsis

  • Sepsis-3 guidelines are recommending a change in our definition of sepsis. In order to implement a change in the definitions we would need to implement the SOFA SCORE calculation or tool.
  • The definition of sepsis is an increase in the SOFA score of 2 points or more because of an infection.

The SOFA score identifies organ dysfunction.

  • I have been utilizing this tool for some of my patients and think that it is feasible to use the SOFA score. The new definitions of sepsis and septic shock and the use of SOFA does seem more scientific and accurate. It does help the data collector make a more educated determination of the condition. You rarely have to use all the parameters in the SOFA score because getting an increase in the score by 2 is usually apparent with little effort.
    • I have broken down the elements of SOFA and written any possible issues in the availability or collectability of each:
    • 1. PaO2/FiO2: Need a calculator to determine this
    • 2. Platelets: easily obtained on EPR labs
    • 3. Bilirubin: obtained on EPR labs, but not done daily or routinely
    • 4. BP/ pressor usage: obtained from ICU flow sheets and the MAR.
    • 5. GCS: difficult to accurately determine r/t the prevalence of sedation in the ICU.
    • 6. Creatinine: Baseline not always available.
    • 7. Urine output: can be obtained on the ICU flow sheets but not available on EPR
  • For Septic shock definition: Need the use of Vasopressors and a serum lactate of greater than 2, despite adequate volume resuscitation. Lactate levels are usually done for suspected sepsis but may not always be available.
  • I personally think the definitions make more sense and would like to see this change in our practice.
    • (There would no longer be SIRS or severe sepsis. The only options are specific infections, sepsis or septic shock utilizing the new definitions). p:Laura Kolesar - Wednesday, February 14, 2018 7:51 AM. (as per email).

Other Literature Reference

Assessment of Clinical Criteria for Sepsis for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)-2016_Feb_23

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