A French group, Ait-Oufella et al, has published two papers focusing on a classical sign of septic circulatory shock, skin mottling. Skin mottling is the patchy skin discolouration we see in poorly perfused patients and is thought to represent poor microcirculation.
Based on the observation that it is most commonly seen on the patient’s knees the authors designed a score based on the extent of mottling. Basically, the sicker the patient, the larger the extent of the mottling area.
0 – No mottling
1 – Coin sized mottling area on the knee.
2 – To the superior area of the knee cap.
3 – Mottling up to the middle thigh
4 – Mottling up to the fold of the groin
5 – Severe mottling that extends beyond the the groin.
6 hours post-admission, arterial lactate levels, urinary output and mottling score were predictive of 14-day mortality. Of these, mottling score was the strongest predictor.
Interestingly, MAP, CVP, HR and cardiac index at 6 hours were not significantly associated with 14-day mortality.
Courtesy of ScanCrit.Com
Intensive Care Med. 2011 May;37(5):801-7. doi: 10.1007/s00134-011-2163-y. Epub 2011 Mar 4. Mottling score predicts survival in septic shock. Ait-Oufella H1, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, Joffre J, Margetis D, Guidet B, Maury E, Offenstadt G.