Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study
Autoři:
Gunnar Husabø aff001; Roy M. Nilsen aff003; Hans Flaatten aff004; Erik Solligård aff005; Jan C. Frich aff007; Gunnar T. Bondevik aff002; Geir S. Braut aff009; Kieran Walshe aff011; Stig Harthug aff012; Einar Hovlid aff001
Působiště autorů:
Department of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
aff001; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
aff002; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
aff003; Department of Clinical Medicine, University of Bergen, Bergen, Norway
aff004; Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
aff005; Department of Circulation and Medical Imaging and Mid-Norway Sepsis Research Group, Norwegian University of Science and Technology, Trondheim, Norway
aff006; Institute of Health and Society, University of Oslo, Oslo, Norway
aff007; National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
aff008; Stavanger University Hospital, Stavanger, Norway
aff009; Norwegian Board of Health Supervision, Oslo, Norway
aff010; Alliance Manchester Business School, University of Manchester, Manchester, England, United Kingdom
aff011; Department of Research and Development, Haukeland University Hospital, Bergen, Norway
aff012; Department of Clinical Science, University of Bergen, Bergen, Norway
aff013
Vyšlo v časopise:
PLoS ONE 15(1)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227652
Souhrn
Background
Early recognition of sepsis is critical for timely initiation of treatment. The first objective of this study was to assess the timeliness of diagnostic procedures for recognizing sepsis in emergency departments. We define diagnostic procedures as tests used to help diagnose the condition of patients. The second objective was to estimate associations between diagnostic procedures and time to antibiotic treatment, and to estimate associations between time to antibiotic treatment and mortality.
Methods
This observational study from 24 emergency departments in Norway included 1559 patients with infection and at least two systemic inflammatory response syndrome criteria. We estimated associations using linear and logistic regression analyses.
Results
Of the study patients, 72.9% (CI 70.7–75.1) had documented triage within 15 minutes of presentation to the emergency departments, 44.9% (42.4–47.4) were examined by a physician in accordance with the triage priority, 44.4% (41.4–46.9) were adequately observed through continual monitoring of signs while in the emergency department, and 25.4% (23.2–27.7) received antibiotics within 1 hour. Delay or non-completion of these key diagnostic procedures predicted a delay of more than 2.5 hours to antibiotic treatment. Patients who received antibiotics within 1 hour had an observed 30-day all-cause mortality of 13.6% (10.1–17.1), in the timespan 2 to 3 hours after admission 5.9% (2.8–9.1), and 4 hours or later after admission 10.5% (5.7–15.3).
Conclusions
Key procedures for recognizing sepsis were delayed or not completed in a substantial proportion of patients admitted to the emergency department with sepsis. Delay or non-completion of key diagnostic procedures was associated with prolonged time to treatment with antibiotics. This suggests a need for systematic improvement in the initial management of patients admitted to emergency departments with sepsis.
Klíčová slova:
Antibiotics – Critical care and emergency medicine – Death rates – Diagnostic medicine – Norwegian people – Physicians – Sepsis – triage
Zdroje
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