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The Outcomes of Severe Sepsis in Homeless FREE TO VIEW

Shahryar Ahmad; Saqib Baig; Amit Taneja; Rahul Nanchal; Gagan Kumar
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Medical College of Wisconsin, Milwaukee, WI

Chest. 2014;146(4_MeetingAbstracts):230A. doi:10.1378/chest.1995140
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SESSION TITLE: Sepsis & Septic Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Severe sepsis requires timely management and adverse outcomes if the care is delayed. Homeless patients are more likely to delay seeking care and for various reasons they may also receive less intensive care. We tested the hypothesis that the mortality rate in severe sepsis is higher among homeless patients using the Healthcare Costs and Utilization Project’s - California State Inpatient Database

METHODS: We used ICD-9-CM codes indicating the presence of sepsis and organ system failure to identify hospitalizations for severe sepsis between 2006 and 2011. We compared the outcomes of homeless persons with those who were privately insured. We performed multivariate logistic regression to adjust for patient and hospital characteristics and to examine the association of homeless status and in-hospital mortality. We also looked at the impact of homelessness status on readmissions and length of stay

RESULTS: There were 640,954 discharges with severe sepsis from 2006 through 2011. Homeless people, who accounted for 0.27% of admissions with severe sepsis, had higher adjusted odds of mortality (OR 1.40, 95%CI 1.25-1.56) than privately insured people. When adjusted for severity, the odds ratios for mortality in homeless improved (OR 0.61; 95%CI 0.44-0.87) suggesting the increased mortality was secondary to severity of disease. The median length of hospital stay amongst survivors was longer in the homeless (13 days vs. 9 days, p<0.001) and the 30 day readmissions rates were significantly lower (1.2% vs. 2.9%, p<0.001).

CONCLUSIONS: Homeless patients are more likely to die following admission for severe sepsis than those with insurance. Increased severity of disease, which is likely result of delayed presentation, seems to be the underlying cause of increased mortality

CLINICAL IMPLICATIONS: Because of delay in presentation and high mortality early identification of for agressive management of sepsis is the key in improving outcomes in homeless patients.

DISCLOSURE: The following authors have nothing to disclose: Shahryar Ahmad, Saqib Baig, Amit Taneja, Rahul Nanchal, Gagan Kumar

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