SESSION TITLE: Sepsis
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 01:30 PM - 02:30 PM
PURPOSE: We attempted to identify variables which may impact mortality in severe sepsis, particularly time spent in the emergency department (ED).
METHODS: A retrospective chart review was performed on our sepsis registry which includes consecutive patients admitted with severe sepsis from the ED to the MICU from 2010-2013. Patients were included if 1) over 18 years old 2) met severe sepsis criteria 3) Had SBP<90 or lactate >=4 mmol/L. Variables assessed included ED triage to antibiotic time, triage to lactate time, lactate clearance, ED length of stay (LOS), 30 ml/kg IV fluid, 20 ml/kg IV fluid, or 1 liter IV fluid administration. Primary outcome was mortality. Analysis employed a combination of Chi-square and two-tailed Fisher exact tests with a p value of 0.05 taken as significant.
RESULTS: 164 patients with severe sepsis had an in-hospital mortality rate of 26.8%, a 28 day mortality rate of 32.3%, and a use of invasive mechanical ventilation (MV) rate of 45.1%. Most variables did not show a significant difference in outcomes with the exception of initial lactate ≥ 4 and length of stay in the ED. The amount of fluid bolus delivered in the first 3 hrs did not significantly impact outcomes. Compared to ED LOS < 6 hours, patients with an ED LOS ≥ 6 hrs had significantly better outcomes for in-hospital mortality (RR 1.86, 95% CI: 0.99-3.49, p=0.040), and 28 day mortality (RR 1.79, 95% CI: 1.03-3.14, p=0.035). ED LOS < 6 hrs was associated with lactate ≥ 4 (RR 1.76, 95% CI: 1.01-3.05, p=0.034); and patients with an initial lactate ≥ 4 demonstrated higher 28 day mortality (RR 2.02, 95% CI: 1.29-3.17, p=0.003). ED LOS <6 hrs was associated with more MV but not with shock or use of vasopressors.
CONCLUSIONS: We determined that a shorter ED LOS identified sicker patients at higher risk of mortality. Spending a longer time in the ED was not associated with adverse outcomes. Our study was limited by a small sample size in a single institution.
CLINICAL IMPLICATIONS: Sicker patients with severe sepsis were triaged appropriately to the MICU, but increased ED LOS did not translate into worse outcomes. Therefore, septic patients may be stabilized in an ED setting without risk of increased mortality from delayed ICU admission.
DISCLOSURE: The following authors have nothing to disclose: Aruna Jahoor, Thomas Delmas, Badri Giri, Lori Murdoch, Jessica Pruszynski, Christopher Spradley, Alejandro Arroliga, Shekhar Ghamande
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