The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study

Hanson, Josh; Smith, Simon; Brooks, James D.; Groch, Taissa; Sivalingam, Sayonne; Curnow, Venessa; Carter, Angus; Hargovan, Satyen

doi:10.1371/journal.pone.0236339

Cited by 13 publications

(16 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately 17% of the local population identifies as an Aboriginal and/or Torres Strait Islander Australian [ 11 ]. Many members of these Indigenous communities experience significant socioeconomic disadvantage and, accordingly, a high burden of comorbidities, increasing their susceptibility to infection, including CNS disease [ 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients’ demographic characteristics and their clinical course. Results There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens–including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/84, 6%)–were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case—a dengue infection in 2009—diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia’s well-resourced public health system is likely to have contributed to the cohort’s low case-fatality rate.

show abstract

Section: Introductionmentioning

confidence: 99%

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…Both of these risk factors—markers of greater socioeconomic disadvantage—were more common in the Indigenous patients in this series and might be responsible for their over-representation in this cohort. Indeed, smoking and hazardous alcohol make a significant contribution to the disproportionate burden of communicable and non-communicable diseases in the local Indigenous population and are an obvious target for more aggressive preventative health strategies in the region [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia

et al. 2022

Self Cite

View full text Add to dashboard Cite

Cryptococcal infections are an important cause of morbidity and mortality in tropical Australia. This retrospective audit was conducted to characterise the aetiology, temporospatial epidemiology, and clinical course of 49 cryptococcal infections in Far North Queensland between 1 January 1999 and 31 December 2019. Cryptococcus gattii was identified in 15/32 (47%) in whom it was possible to speciate the organism. Among these 15 patients, 13 (87%) had a rural residential address, 10 (67%) were Indigenous Australians and 11 (73%) presented during the May-November dry season. When compared to the 17 patients with Cryptococcus neoformans infection, patients with C. gattii were less likely to be immunocompromised (0/15 versus 8/17 (47%), p = 0.003). Neurosurgery was necessary in 5/15 C. gattii cases and 3/17 (18%) C. neoformans cases (p = 0.42). Outcomes were generally good with 42/49 (86%) cases—and 14/15 (93%) with C. gattii infection—surviving to hospital discharge. These positive outcomes are likely to be explained by the development of standardised treatment guidelines during the study period, low rates of comorbidity in the patients with C. gattii infection and access to liposomal amphotericin and neurosurgical support in the well-resourced Australian healthcare system.

show abstract

“…A Waikato study found that Māori patients are three times more likely to develop sepsis and are at increased risk of hospital death 9 . Variation in health outcomes according to ethnicity is not unique to NZ; Indigenous Australians are more likely to die from sepsis at a younger age, 33 and in the USA, African American and Hispanic patients have higher rates of sepsis and are more likely to be admitted to ICU 34 . It is therefore prudent that this increased risk for ethnic minority populations is accounted for in ED management strategies in order to provide equitable care.…”

Section: Discussionmentioning

confidence: 99%

Exploring nursing and medical perceptions of sepsis management in a New Zealand emergency department: A qualitative study

Rogan

Lockett

Peckler

et al. 2021

Emerg Medicine Australasia

View full text Add to dashboard Cite

Objective: Early sepsis recognition and treatment are essential in order to reduce the burden of disease. Initial assessment of patients with infection is often undertaken by ED nurses and resident doctors. This descriptive qualitative study aimed to explore their perceptions and perspectives regarding the factors that impede the identification and management of patients with sepsis. Methods: This was a qualitative study conducted between 30 January 2020 and 27 February 2020. Semi-structured focus group interviews were performed to collect data. All participants provided written informed consent and completed a basic demographic and work experience form. Two study investigators facilitated the interviews. Interviews were audio-recorded and later transcribed. Thematic analysis was performed with the aid of NVivo 12 software. Results: Six focus group interviews were conducted involving 40 ED nurses and doctors. Interview length ranged from 27 to 38 min (mean 33.5 min). Three major themes were identified: (i) clinical management; (ii) challenges and delays; and (iii) communication. Each of these themes was broken down into subthemes, which are presented in more detail. Conclusion: ED nurses and doctors have identified important factors that limit and enhance their capacity to recognise and respond to patients with sepsis. Complex interactions exist between clinical and organisational structures that can affect the care of patients and the ability of clinicians to provide optimal care. The three major themes and specific subthemes provide a useful framework and stimulus for service improvements and research that could help foster future sepsis management improvement strategies.

show abstract

The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: An observational study

Abstract: Background Indigenous Australians suffer a disproportionate burden of sepsis, however, the performance of scoring systems that predict mortality in Indigenous patients with critical illness is incompletely defined.

Cited by 13 publications

References 32 publications

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

The aetiology and clinical characteristics of cryptococcal infections in Far North Queensland, tropical Australia

Exploring nursing and medical perceptions of sepsis management in a New Zealand emergency department: A qualitative study

Contact Info

Product

Resources

About