• Romain Jouffroy, Anastasia Saade, Jean Pierre Tourtier, Papa Gueye, Emmanuel Bloch-Laine, Patrick Ecollan, Pierre Carli, and Benoît Vivien.
• Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker - Enfants Malades, 149 rue de Sèvres, 75015 Paris, University Paris Descartes, France; Department of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada. Electronic address: romain.jouffroy@aphp.fr.
• Am J Emerg Med. 2019 Apr 1; 37 (4): 664-671.

ObjectivesThe early identification of septic shock patients at high risk of poor outcome is essential to early initiate optimal treatments and to decide on hospital admission. Biomarkers are often used to evaluate the severity. In prehospital settings, the availability of biomarkers, such as lactate, is restricted. In this context, clinical tools such as skin mottling score (SMS) and capillary refill time (CRT) are more suitable. In this study, we describe prehospital SMS and CRT's ability to predict mortality of patients with septic shock initially cared in the prehospital setting by a mobile intensive care unit.MethodsPatients with septic shock who received prehospital medical care admitted to the intensive care unit were retrospectively analyzed.ResultsSixty-three patients were included. The origin of sepsis was mainly pulmonary (67%). Overall mortality reached 36%. No significant difference was observed in the duration of prehospital medical care between alive and deceased patients. Mean prehospital value of SMS was 3 ± 2 and mean prehospital value of CRT was 5 ± 1 s. A significant association was found between mortality and prehospital SMS (p = 0.02, OR[CI95] = 1.50 [1.08-2.15]) and prehospital CRT (p = 0.04, OR[CI95] = 1.53 [1.04-2.37]). After adjusting for confounding factors using propensity score, the relative risk of death was 6.58 for SMS > 2 and 2.03 for CRT > 4 s.ConclusionIn this study, we report an association between prehospital SMS and CRT, and mortality of patients with septic shock. SMS and CRT are simple tools that could be used to optimize the triage and to decide early intensive care admission.Copyright © 2018 Elsevier Inc. All rights reserved.

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