Diagnostic investigation of shock (DiPS study)

Kakhi, Sorayya 2022. Diagnostic investigation of shock (DiPS study). MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Abstract Background: Despite advancement in diagnostic and therapeutic measures, mortality of shock remains high. Identifying patients at highest risk of deterioration is of great interest to clinicians. The main purpose of this study is to investigate the diagnostic ability of USCOM as a feasible, Doppler-based technique in ED. Also, to assess how USCOM improves identification and classification of shock at early stages and help clinician gestalt. At last, to validate Li priori definition of shock; in different settings and assess clinician gestalt. Methods: Study was held at University Hospital of Wales. Ethics approval was sought from Wales Research Ethics Committee II with authority to approve projects involving adults lacking capacity to consent. All adult patients aged ≥ 18 years old, with initial NEWS score of ≥ 3, were recruited within one hour of ED arrival. Results: A total of 359 patients, 46.5% male, were included in the analysis. SVV was found to be the only independent predictor of poor outcome (P value: 0.021, AUC: 0.62, sensitivity and specificity: 60% and 56% respectively). Based on proposed haemodyanmic criteria, analysis of grouped data showed that there is no significant association between shock groups and mortality (P value: 0.52). Using regression analysis, LiPS additive score was validated in internal and external settings, with high performance ability (P value: 0.0006, 0.0003 and 0.005, AUC: 0.77, 0.71 and 0.62 in three cohorts respectively). DiPS as a novel diagnostic model of shock, uses a combination of physiological and laboratory values, and shown to have excellent diagnostic ability in predicting outcome, (AUC of 0.813, accuracy: 83.3% and P value < 0.0001). LiPS diagnostic tool did not agree with clinical impression of shock. However, USCOM and clinicians had acceptable agreement on diagnosis of (Possible) shock. SVV is an independent predictor of shock outcome. DiPs as a quantitative measure of shock can be used parallel to LiPS to improve detection and risk stratification of shock in ED. Conclusion: SVV is an independent predictor of shock outcome. DiPs as a quantitative measure of shock can be used parallel to LiPS to improve detection and risk stratification of shock in ED. Key words: DiPS: Diagnostic Investigation and Prediction of Shock. LiPS: Li Priori Shock, SVV: Stroke Volume Variability, USCOM: Ultrasonic cardiac output monitor

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Uncontrolled Keywords:	DiPS: Diagnostic Investigation and Prediction of Shock. LiPS: Li Priori Shock, SVV: Stroke
Date of First Compliant Deposit:	20 March 2023
Last Modified:	20 Mar 2024 02:30
URI:	https://orca.cardiff.ac.uk/id/eprint/157818

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