{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:05:58Z","timestamp":1753891558459,"version":"3.41.2"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014037","name":"National Defense Science and Engineering Graduate","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014037","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Usual care regarding vasopressor initiation is ill-defined. We aimed to develop a quantitative \u201cdynamic practice\u201d model for usual care in the emergency department (ED) regarding the timing of vasopressor initiation in sepsis. In a retrospective study of 589 septic patients with hypotension in an urban tertiary care center ED, we developed a multi-variable model that distinguishes between patients who did and did not subsequently receive sustained (&amp;gt;24 h) vasopressor therapy. Candidate predictors were vital signs, intravenous fluid (IVF) volumes, laboratory measurements, and elapsed time from triage computed at timepoints leading up to the final decision timepoint of either vasopressor initiation or ED hypotension resolution without vasopressors. A model with six independently significant covariates (respiratory rate, Glasgow Coma Scale score, SBP, SpO<jats:sub>2<\/jats:sub>, administered IVF, and elapsed time) achieved a C-statistic of 0.78 in a held-out test set at the final decision timepoint, demonstrating the ability to reliably model usual care for vasopressor initiation for hypotensive septic patients. The included variables measured depth of hypotension, extent of disease severity and organ dysfunction. At an operating point of 90% specificity, the model identified a minority of patients (39%) more than an hour before actual vasopressor initiation, during which time a median of 2,250 (IQR 1,200\u20133,300) mL of IVF was administered. This single-center analysis shows the feasibility of a quantitative, objective tool for describing usual care. Dynamic practice models may help assess when management was atypical; such tools may also be useful for designing and interpreting clinical trials.<\/jats:p>","DOI":"10.3389\/fmed.2022.715856","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T10:12:19Z","timestamp":1646993539000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Modeling of Usual Care: Vasopressor Initiation for Sepsis With Hypotension"],"prefix":"10.3389","volume":"9","author":[{"given":"Varesh","family":"Prasad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew T.","family":"Reisner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James C.","family":"Lynch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael R.","family":"Filbin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Heldt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1001\/jama.2014.5804","article-title":"Hospital deaths in patients with sepsis from 2 independent cohorts","volume":"312","author":"Liu","year":"2014","journal-title":"JAMA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014","volume":"318","author":"Rhee","year":"2017","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA."},{"key":"B4","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016","volume":"43","author":"Rhodes","year":"2017","journal-title":"Intensive Care Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s00134-018-5085-0","article-title":"The surviving sepsis campaign bundle: 2018 update","volume":"44","author":"Levy","year":"2018","journal-title":"Intensive Care Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.annemergmed.2018.03.039","article-title":"Liberal versus restrictive intravenous fluid therapy for early septic shock: rationale for a randomized trial","volume":"72","author":"Self","year":"2018","journal-title":"Ann Emerg Med."},{"key":"B7","unstructured":"SimpsonSQ\n          18480389Four-Leafed CLOVERS or Otherwise? 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