PURPOSE: We noted a difference in outcome between patients with Community Acquired Severe Sepsis (CASS) versus patients with Hospital Acquired Severe Sepsis (HASS) at our institution and designed a study of factors that might explain this difference. We choose to analyze patients with CASS admitted to the MICU via the Emergency Department (ED) compared to patient transfers from within the hospital into the MICU for HASS. Both patient groups were treated for Severe Sepsis (SS) with the same MICU standardized Sepsis Guideline.
METHODS: The records of 53 MICU patients with SS, between June 2004 and March 2006, were retrospectively reviewed. Data collection included: a) initial location of each patient without prior hospitalization as the definition of CASS versus HASS, b) patient demographics, c) APACHE II scores, d) milestones of Early Goal Directed Therapy (EGDT) using our Hahnemann University Hospital Severe Sepsis Guideline as outlined in Chest 2004; 126(4, Suppl):863S and Chest 2005; 128(4, Supp): 181S, and, e) outcome as 28 day mortality. A spreadsheet and statistical analyses was prepared using Microsoft Excel. This project was approved by our IRB.
RESULTS: There were no differences in patient demographics. CASS patients (n=24) have a higher APACHEII score (28 vs. 25) and higher mortality (46% vs. 21%) than HASS patients (n=29). No statistically significant differences in EGDT milestones was noted.
CONCLUSION: 1) CASS patients have significantly higher mortality compared to HASS patients despite similar characteristics by demographics, and severity of illness. Time to EGDT milestones and therapeutic interventions were also similar. 2) Some difference between patients with CASS vs. HASS may be attributed to the latter group developing Sepsis in a monitored healthcare setting which may prevent the delays that would be seen upon initial ED presentation.
CLINICAL IMPLICATIONS: Outcome differences between patients with CASS and HASS may be due to delays in seeking attention in the ED compared to HASS patients. Further studies are needed to better define CASS and HASS as distinct entities of SS that may result in different outcomes.
DISCLOSURE: Martin Schwarcz, None.