Diagnostic uncertainty is a major challenge for patients presenting to Emergency Department (ED) with a variety of signs and symptoms. Over 30% of septic shock patients present with vague symptoms that may be missed by electronic medical record (EMR) alerts resulting in a longer time to antibiotics and worse outcomes.¹ Early identification and appropriate management in the initial hours of sepsis onset improve outcomes, similar to other time-sensitive emergencies such as polytrauma, acute myocardial infarctions or stroke.²

A multi-center observational study at Barnes Jewish Hospital in St. Louis, MO and Baylor Scott and White Medical Center in Temple, TX sought to investigate Monocyte Distribution Width's (MDW) ability to reduce time to first antibiotics ordered by physician. The study screened 1,676 adult patients who presented in the ED and had a Complete Blood Count (CBC) with Differential (CBC-Diff) ordered as part of their standard of care. In this study, the CBC-Diff (with the MDW biomarker) was measured within 2 hours of specimen collection. In total, 191 patients were categorized into the sepsis cohort*. Of these, 132 had an abnormal MDW result^† and could have benefitted from earlier antibiotic administration—30 minutes minutes after the CBC-Diff draw.

The study found:

• The performance of the MDW biomarker for detecting risk of severe infection and sepsis was found to be in concordance with 3 recent United States and European Union studies (data not shown)
• 46% (61/132) of sepsis patients did NOT have antibiotics ordered within 3 hours of ED presentation
• With the MDW biomarker available within 30 min of CBC-Diff draw for physicians to incorporate into their decision making, 92% (122/132) of patients could have received antibiotics within 3 hours of ED presentation

*Met ≥2 SIRS criteria + blood drawn for microbial testing within 24 hours and confirmed as infected by study physician^† MDW result (>20; K2EDTA)

To Read the Full Study: Click here

Source: Osborn, T. et al. (2021). 90 Potential to Improve Treatment Decision Time with the Early Sepsis Indicator, Monocyte Distribution Width, in Patients Presenting to the Emergency Department with Suspicion of Infection. Ann. Emerg. Med. 78, S36.https://doi.org/10.1016/j.annemergmed.2021.09.099

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1. Filbin, R. et al., (2018). Presenting Symptoms Independently Predict Mortality in Septic Shock: Importance of a Previously Unmeasured Confounder. Critical Care Medicine, 46(10), 1592–1599. https://doi.org/10.1097/CCM.0000000000003260

2. Rhodes, A. et al. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43(3), 304–377. https://doi.org/10.1007/s00134-017-4683-6