Critical Care: Sepsis I |

ICU Admission Source as a Predictor of Mortality for Patients With Sepsis FREE TO VIEW

Christine Motzkus, MPH; Stavroula Chrysanthopoulou, PhD; Roger Luckmann, MD; Kate Lapane, PhD; Craig Lilly, MD
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University of Massachusetts Medical School, Worcester, MA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):353A. doi:10.1016/j.chest.2016.08.366
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Prompt recognition, fluid resuscitation, and administration of antimicrobials are key determinants of outcomes for adults with life threatening infections. This study compared mortality outcomes of critically ill adults from moderate resource emergency departments (ED) to patients from lower resource hospital wards, and higher resource operating rooms.

METHODS:Design: Retrospective cohort study Setting: A granular and well-described critical care database from a large academic medical center Patients: 1,762 adults who met the consensus case definition for sepsis diagnosed within 48 hours of intensive care unit (ICU) admission Measurements: Survival analysis provided hazard rate ratio (HRR) estimates comparing hospital mortality for patients from 3 admission sources, adjusted for age, gender, and illness severity and 95% confidence intervals (CI).

RESULTS: Admission source predicted mortality with a step-wise relation of survival with admission site resource intensity. Lower resource hospital ward patients had higher raw and adjusted mortality (Adjusted Hazard Rate Ratio 1.35 95% Confidence Interval: 1.09-1.68) than patients admitted from moderate resource ED sites. Patients admitted from higher resource operating room sites had lower mortality (Adjusted Hazard Rate Ratio: 0.37 95% Confidence Interval 0.23-0.58) than those admitted from the ED.

CONCLUSIONS: The association of resource availability at the site where sepsis is recognized and treated with better survival supports the contention that early recognition, expeditious treatment, and operative source control are important determinants of mortality.

CLINICAL IMPLICATIONS: These associations are important because they suggest that providing resources sufficient to detect and efficiently treat those with sepsis may save lives. The findings are consistent with clinical trial data and consensus treatment recommendations linking better outcomes to processes that better recognize those with sepsis, more rapidly provide effective antimicrobials, more completely resuscitate the septic patient, and provide source control. The findings of this study imply that increasing resource availability may improve outcomes for those with sepsis.

DISCLOSURE: The following authors have nothing to disclose: Christine Motzkus, Stavroula Chrysanthopoulou, Roger Luckmann, Kate Lapane, Craig Lilly

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