Epidemiology of Severe Sepsis in the Emergency Department and Difficulties in the Initial Assistance

Abstract

BACKGROUNDThe aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department.METHODSA prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital.RESULTSA total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65–84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15–25) and 5 (3–7), respectively. The median number of dysfunctional organ systems per patient was 2 (1–3). The median hospital length of stay was 10 (4.7–17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12–48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU.CONCLUSIONSThe occurrence rate of severe sepsis in the emergency department was 6.4%, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis.

A large Venous-Arterial PCO2Is Associated with Poor Outcomes in Surgical Patients

“…Currently, few parameters are used at bed side to assess tissue hypoxia, such as urinary output, base differences, and blood lactate, but those parameters show that hypoperfusion is already installed and may be late to guide the onset of a hemodynamic resuscitation [18]. However, in this study, [P(v-a)CO 2 ] has proven to be an early parameter to identify worse outcome in surgery patients.…”

Difference in Patient Outcomes Coming From Public and Private Hospitals in an Intensive Care Unit in Brazil

“…Thus, we conclude that the impact on patient morbidity and mortality can be attributed not only to the quality of care in an ICU but also to other factors, such as the health system in which the ICU is located. It is well known that, in public hospitals in Brazil, the conditions for the appropriate treatment of critically ill patients are insufficient due to the high influx of patients, lack of resources, and lack of trained staff [20]. Measures to ensure an appropriate early treatment in an emergency environment for critically ill patients could result in significant decreases in mortality and a subsequent reduction in costs.…”

Febrile neutropenia in French emergency departments: results of an analysis of practice in a prospective multicentre survey

“…L'évaluation initiale des signes de sévérité est malheureusement rendue difficile par un état clinique qui paraît parfois faussement rassurant et une évolution possible durant l'attente aux urgences [17]. Une étude menée au Brésil a rapporté que les urgentistes étaient capables de repérer des infections sévères dans 15,8 % des cas [21]. La mise en place de recommandations par la Surviving Sepsis Campaign a permis d'améliorer la détection des infections graves, mais 61,5 % des patients restent insuffisamment traités en raison d'une évaluation incorrecte.…”