Quality of Life of Severe Sepsis Survivors After Hospital Discharge

Contrin, Lígia Márcia; Paschoal, Vânia Del'Arco; Beccária, Lúcia Marinilza; Cesarino, Cláudia Bernardi; Lobo, Suzana Margareth

doi:10.1590/s0104-11692013000300020

Cited by 16 publications

(20 citation statements)

References 22 publications

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“…After title and abstract screening, 82 potentially relevant records were identified and after full text screening nine studies (10 papers [84][85][86][87][88][89][90][91][92][93] ) were considered eligible for inclusion ( Figure 22). This included one study 84 conducted for paediatric patients at the ED, one study 85 conducted in a paediatric ICU and six studies conducted in adult patients at the ICUs.…”

Section: Resultsmentioning

confidence: 99%

“…This included one study 84 conducted for paediatric patients at the ED, one study 85 conducted in a paediatric ICU and six studies conducted in adult patients at the ICUs. [86][87][88][89][90][91][92] Moreover, for one study 93 (abstract only) the specific setting (other than in-hospital) was not stated but the study was likely to have been conducted in an ICU setting, as it included patients with severe sepsis of presumed infectious origin; we have therefore assumed that this study was conducted in an ICU setting. The HRQoL studies are described in more detail below and summarised in Appendix 6.…”

Section: Resultsmentioning

confidence: 99%

“…All seven studies [86][87][88][89][90][91][92][93] that considered adult patients with sepsis, who were being treated in the ICU, used the European Quality of Life-5 Dimensions (EQ-5D) to elicit utility scores. Only one 93 of these studies (abstract only) reported short-term utility scores for a sepsis patient group (n = 93) that stayed in hospital (56% of the patients were in the hospital at day 30).…”

Section: Adult Intensive Care Unitmentioning

confidence: 99%

“…Only one 93 of these studies (abstract only) reported short-term utility scores for a sepsis patient group (n = 93) that stayed in hospital (56% of the patients were in the hospital at day 30). This study 93 86,87 for patients 1 year or later after discharge. The long-term utility values varied substantially between studies.…”

Section: Adult Intensive Care Unitmentioning

confidence: 99%

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Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

Westwood

Ramaekers

Whiting

et al. 2015

Health Technol Assess

111

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BackgroundDetermination of the presence or absence of bacterial infection is important to guide appropriate therapy and reduce antibiotic exposure. Procalcitonin (PCT) is an inflammatory marker that has been suggested as a marker for bacterial infection.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of adding PCT testing to the information used to guide antibiotic therapy in adults and children (1) with confirmed or highly suspected sepsis in intensive care and (2) presenting to the emergency department (ED) with suspected bacterial infection.MethodsTwelve databases were searched to June 2014. Randomised controlled trials were assessed for quality using the Cochrane Risk of Bias tool. Summary relative risks (RRs) and weighted mean differences (WMDs) were estimated using random-effects models. Heterogeneity was assessed visually using forest plots and statistically using theI2andQstatistics and investigated through subgroup analysis. The cost-effectiveness of PCT testing in addition to current clinical practice was compared with current clinical practice using a decision tree with a 6 months’ time horizon.ResultsEighteen studies (36 reports) were included in the systematic review. PCT algorithms were associated with reduced antibiotic duration [WMD –3.19 days, 95% confidence interval (CI) –5.44 to –0.95 days,I2 = 95.2%; four studies], hospital stay (WMD –3.85 days, 95% CI –6.78 to –0.92 days,I2 = 75.2%; four studies) and a trend towards reduced intensive care unit (ICU) stay (WMD –2.03 days, 95% CI –4.19 to 0.13 days,I2 = 81.0%; four studies). There were no differences for adverse clinical outcomes. PCT algorithms were associated with a reduction in the proportion of adults (RR 0.77, 95% CI 0.68 to 0.87; seven studies) and children (RR 0.86, 95% CI 0.80 to 0.93) receiving antibiotics, reduced antibiotic duration (two studies). There were no differences for adverse clinical outcomes. All but one of the studies in the ED were conducted in people presenting with respiratory symptoms.Cost-effectiveness: the base-case analyses indicated that PCT testing was cost-saving for (1) adults with confirmed or highly suspected sepsis in an ICU setting; (2) adults with suspected bacterial infection presenting to the ED; and (3) children with suspected bacterial infection presenting to the ED. Cost-savings ranged from £368 to £3268. Moreover, PCT-guided treatment resulted in a small quality-adjusted life-year (QALY) gain (ranging between < 0.001 and 0.005). Cost-effectiveness acceptability curves showed that PCT-guided treatment has a probability of ≥ 84% of being cost-effective for all settings and populations considered (at willingness-to-pay thresholds of £20,000 and £30,000 per QALY).ConclusionsThe limited available data suggest that PCT testing may be effective and cost-effective when used to guide discontinuation of antibiotics in adults being treated for suspected or confirmed sepsis in ICU settings and initiation of antibiotics in adults presenting to the ED with respiratory symptoms and suspected bacterial infection. However, it is not clear that observed costs and effects are directly attributable to PCT testing, are generalisable outside people presenting with respiratory symptoms (for the ED setting) and would be reproducible in the UK NHS. Further studies are needed to assess the effectiveness of adding PCT algorithms to the information used to guide antibiotic treatment in children with suspected or confirmed sepsis in ICU settings. Additional research is needed to examine whether the outcomes presented in this report are fully generalisable to the UK.Study registrationThis study is registered as PROSPERO CRD42014010822.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Adult Intensive Care Unitmentioning

confidence: 99%

Section: Adult Intensive Care Unitmentioning

confidence: 99%

See 2 more Smart Citations

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

Westwood

Ramaekers

Whiting

et al. 2015

Health Technol Assess

111

View full text Add to dashboard Cite

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“…Infectious diseases are usually diagnosed with associated increasing severity and mortality, which may partly justify the presence of more complex levels of care and its adverse outcomes, such as death and prolonged hospitalization, as found in this study (17) .…”

Section: Discussionmentioning

confidence: 61%

Nursing staff sizing in the emergency room of a university hospital

Paixão

Campanharo

Lopes

et al. 2015

Rev. esc. enferm. USP

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Objective: To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. Method: The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. Results: The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. Conclusion: A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed. Nursing staff sizing in the emergency room of a university hospital Dimensionamento de enfermagem em sala de emergência de um hospital-escola Dimensionamiento de enfermería en servicio de urgencias de un hospital escuela

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