Factors affecting early treatment goals of sepsis patients presenting to the emergency department

Abstract

Background and Objectives:Sepsis is a major cause of emergency medicine admission. It is associated with high mortality and morbidity. Even though sepsis is common in the Indian subcontinent, there is a paucity of data on the management of sepsis in India. The aim was to study the factors affecting early treatment goals.Methods:All clinically suspected sepsis patients consenting to be part of the study were included. The diagnosis of sepsis was made by the treating physician in the emergency department as per the Surviving Sepsis Guidelines criteria. All cases were managed as per institutional treatment protocol. The patients were prospectively followed up and the time taken to achieve the goal-directed sepsis bundle documented and analyzed.Results and Discussion:Of the 75 patients studied, the 3-hour(h) bundles were achieved in 70.7% of cases and 6-h bundles were achieved in 84% of cases. Meantime for obtaining blood culture was 107 min and administration of first dose antibiotics was 134 min. Thirty patients failed to achieve the early treatment goals, of which six were under-triaged, seven due to physicians delay in recognizing sepsis, 11 due to logistical delay, and six were due to financial constraints.Conclusion:The sepsis bundle goals were not achieved because of various factors such as under triaging, delay in diagnosis, logistical delay, and financial constraints. Further studies on whether sensitization of medical fraternity about sepsis, implementation of insurance policies for patient care or better point of care diagnostics would aid in achieving the bundles may be evaluated further.

Diagnostic Value of Neutrophil Cd64 in Sepsis Patients in the Intensive Care Unit: A Cross-sectional Study

“…The prospective MOSAICS II study conducted at 386 ICUs across 22 Asian countries (including Vietnam) also showed that the overall prevalence of sepsis in ICUs was 22.4%, and the hospital mortality rate of sepsis was 32.6% [4]. It has been well documented that a delay in diagnosis and management of sepsis will cause an increase in mortality and morbidity [5]. Therefore, early detection and adequate treatment in the rst few hours after the development of sepsis can improve outcomes [6].…”

Role of Neutrophil Gelatinase-associated Lipocalin (NGAL) and Other Clinical Parameters as Predictors of Bacterial Sepsis in Patients Presenting to the Emergency Department with Fever

“…A study from India found that 30% of patients with sepsis did not achieve early treatment goals due to various reasons including wrong triaging and physician's not recognizing sepsis. 7 The SIRS was introduced in 1991 in the international consensus guidelines to recognize sepsis, which was then replaced by qSOFA in 2016. 8 However, the diagnostic accuracy of both SIRS and qSOFA is suboptimal with modest sensitivities and specificities of 70% and 73% for qSOFA and 88% and 34% for SIRS, respectively.…”

Diagnostic Value of Neutrophil CD64 in Sepsis Patients in the Intensive Care Unit: A Cross-Sectional Study

“…The prospective MOSAICS II study conducted at 386 ICUs across 22 Asian countries (including Vietnam) also showed that the overall prevalence of sepsis in ICUs was 22.4%, and the hospital mortality rate of sepsis was 32.6% [ 4 ]. It has been well documented that a delay in diagnosis and management of sepsis will cause an increase in mortality and morbidity [ 5 ]. Therefore, early detection and adequate treatment in the first few hours after the development of sepsis can improve outcomes [ 6 ].…”