PURPOSE: Using the Surviving Sepsis Campaign(SSC)data base, this study compares characteristics, treatments and outcomes of septic shock (SS) patients diagnosed in the emergency department (ED) to patients developing SS in the intensive care unit (ICU).
METHODS: The population studied included patients admitted to the medical/surgical intensive care unit of an urban tertiary care medical center during Mar - Dec 2006. 28 SS patients diagnosed in the ED and 10 SS patients diagnosed in the ICU were included . Analysis of acute physiology and chronic health evaluation (APACHE II) scores, systemic manifestations (SSC sepsis screening tool), infection source, hemodynamics, mechanical ventilation (MV), ICU length of stay (LOS) and mortality were reviewed.
RESULTS: ICU SS patients had APACHE II scores of 30.9±5.6 compared to 21.8±7.7 for ED patients, (p = 0.01). A median of 3.3 systemic manifestations of infection were present in ED compared to 2.3 in the ICU patients. Pneumonia was the primary infection in the ICU and urinary tract infection in the ED group. ICU patients had a higher percentage of MV (100%) use during the first 24 hours of shock onset, compared to ED patients 46.4%, (p = 0.01). Inspiratory plateau pressures were higher in the ICU patient group (22±3.2) compared to the ED patient group (16±2.8), (p= 0.03). ICU mortality was 80% compared to 25% for ED patients, (p = 0.01).
CONCLUSION: Mortality was higher in ICU diagnosed SS patients as was use of MV in the first 24 hrs. MV was observed to be related to high mortality in both the ED and ICU patients. Higher APACHE II scores were related to an increase in mortality risk for the ICU patients.
CLINICAL IMPLICATIONS: The data suggest patients who developed SS in ICU are at high risk of death compared to those presenting with SS to the ED. Need for MV may be an important predictor for outcome.
DISCLOSURE: Zhen Wang, No Financial Disclosure Information; No Product/Research Disclosure Information