PURPOSE: This study assessed how well Internal Medicine residents identified severe sepsis and septic shock based on objective parameters.
METHODS: This was a retrospective chart review from May through August 2010. Inclusion criteria were patients with sepsis based on the CDC criteria, demographics, and objective criteria including compliance with septic shock protocol Apache score; primary source of infection; timing of antibiotics, pressors, intravenous fluids (IVF), and final outcomes.
RESULTS: A total of 82 patients were included, with an average age of 69 years (SD +/- 15.2); 53% were males. Forty percent were admitted to the ICU, 33% to a step-down unit, and 27% to a general medical floor. Average APACHE score was 16.6 and average hours until arrival to the final destination was 6.4hrs. Time of the initial antibiotic administration was 2.8 hours, septic shock protocol was only use for 14% of the patients 42% received at least 1400 ml of IVF at presentation and initial CVP measurement was 9 hours. Primary source of infection was 37% lungs, 31% urine and 30% other causes. Source of admission was 43% home, 41% long term facility and 16% sub acute facility. Eighteen percent of patients were discharged home, 32% to long term facility, 16% to sub acute facility, 13% to other facilities, and 21% died.
CONCLUSIONS: Our study clearly defines a multitude of areas in which we could improve upon when identifying septic shock. Specific screening tools for early sepsis recognition, enhanced compliance with standardized protocols, and better compliance with early goal-directed therapy would improve outcomes and further reduce mortality rate. A future study is needed to determine the effect of improvement of these parameters on our mortality rate.
CLINICAL IMPLICATIONS: Our mortality rate for sepsis was within the current average mortality rate in the U.S; however, there are clearly factors that could be improved.
DISCLOSURE: The following authors have nothing to disclose: Miguel Antonatos, Jack Kucharewicz, Samar Dekko, Sonialy Lugo Ruiz
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