Early detection of patient deterioration in patients with infection or sepsis

Sepsis is the leading cause of death and critical illness worldwide. Despite treatment, one in five patients deteriorate within 48 hours from admission. Deterioration includes the development of (multiple) organ dysfunction, the need for ICU admission or death. How patients can be effectively monitored for signs of deterioration remains largely unknown. In this thesis, we explore infection and sepsis-related deterioration from different perspectives, using a variety of instruments ranging from clinical impression, clinical scoring systems and laboratory parameters (biomarkers), to continuous analysis of vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation). We explored whether these instruments can detect (early) signs of patient deterioration in patients presenting with infection or sepsis to the emergency department. The clinical impression of the nurse or treating physician is most helpful to decide whether patients can be admitted to the general ward or need ICU treatment. Clinical scoring systems are most helpful to predict long-term mortality outcomes. Biomarkers lack sensitivity and specificity for their clinical application and (novel) biomarkers are not readily available in the ED. Patterns in the continuous analysis of vital signs, contain valuable information about patient deterioration. However, the main challenge remains to improve their modeling and condense the contained information about the risk of deterioration for individual patients into a usable and understandable format for the clinician. Once these issues are solved, continuous analysis of vital signs could be an easily applicable method for the early warning of deterioration in patients in throughout the hospital.