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Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study is to evaluate the impact of tele-ED consultation on sepsis care and outcomes in rural ED patients. The TELEvISED study is a multicenter (n = 25) retrospective propensity-matched comparative effectiveness study of tele-ED care for rural sepsis patients in a mature tele-ED network. Telemedicine-exposed patients will be matched with non telemedicine patients using a propensity score to predict tele-ED use. The primary outcome is 28-day hospital free days, and secondary outcomes include adherence with guidelines, mortality and organ failure. ClinicalTrials.gov: NCT04441944 .

Asuquo et al.: Community needs assessment of key populations-at-risk of HIV/AIDS in Nigeria's capital territory. BMC Infectious Diseases 2014 14(Suppl 2):P29.

Objective: Sepsis has high mortality, but it is often not recognized due to varied and vague presentations. Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care, but we hypothesized that its use and effectiveness is dependent on local sepsis recognition. The objective of this study was to measure the association between sepsis documentation and tele-ED use, treatment guideline adherence, and mortality. Methods: This analysis was a multicenter (n=23) cohort study of sepsis patients treated in rural emergency departments (EDs) that participated in a tele-ED network between August 2016 and June 2019. The primary exposure was whether sepsis was recognized in the local ED, and the primary outcome was rural tele-ED use, with secondary outcomes of time to tele-ED use, 3-hour guideline adherence, and in-hospital mortality. We used multivariable generalized estimating equation models for our analysis. Results: Data from 1,146 rural sepsis patients were included, 315 (27%) had tele-ED used, and 415 (36%) had sepsis recognized in the rural ED. Sepsis recognition was not independently associated with higher rates of tele-ED use (adjusted odds ratio [aOR] 1.23, 95% CI 0.90-1.67). Sepsis recognition was associated with earlier tele-ED activation (adjusted hazard ratio [aHR] 1.69, 95% CI 1.34-2.13), lower 3-hour guideline adherence (aOR 0.73, 95% CI: 0.55-0.97), and lower in-hospital mortality (aOR 0.72, 95% CI: 0.54-0.97). Conclusions: Sepsis recognition in rural EDs participating in a tele-ED network was not associated with tele-ED use. Future work will focus on how telehealth can be used to improve diagnostic accuracy and sepsis recognition.