Activation of code sepsis in the emergency department is associated with a decrease in mortality

Boter, Neus Robert; Deltell, Josep Maria Mòdol; García, Irma Casas; Blanch, Gemma Rocamora; Beltran, G.; Molas, Anna Carreres

doi:10.1016/j.medcle.2019.01.013

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Sepsis and associated multiple organ failure are among the leading causes of global mortality, posing a serious threat to human quality of life. 15 At present, however, efforts to accurately gauge sepsis severity in affected patients in a timely manner remain difficult. 16 Several scoring systems and clinical biomarkers have been leveraged for the prognostic evaluation of sepsis patients, but owing to the complex nature of this condition, no specific clinical indicator has been reliably shown to predict outcomes in this patient population.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis

Han¹,

Cheng²,

Liao³

et al. 2022

JIR

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At present, simple, accurate, and efficient prognostic tools for the evaluation of cases with early-stage sepsis in the emergency department (ED) are lacking. An increased blood urea nitrogen to albumin ratio (BAR) has previously been shown to be a valuable biomarker with predictive utility in several diseases. The relationship between BAR and sepsis patient outcomes, however, is not well-understood. This exploration was thus developed for the exploration of the link between BAR values and the short-term prognosis of cases with sepsis. Methods: This was a retrospective cohort research of sepsis cases admitted to the West China Hospital of Sichuan University ED from July 2015 to June 2016. Laboratory data were collected upon ED admission, and 7-day all-cause mortality was the primary study endpoint. Relationships between BAR values and APACE II and SOFA scores were generated assessed with correlation coefficient heatmaps. Independent risk factors were identified through multivariate analyses, with the curves of receiver operating characteristic (ROC) being employed to gauge the value of BAR as a predictor of the risk of mortality in sepsis cases. Results: In sum, 801 patients participated in the present investigation. BAR values were strongly correlated with APACHE II and SOFA scores. In a multivariate logistic regression assessment, BAR was identified as an independent predictor of mortality among patients with sepsis (HR=1.032, 95% CI: 1.010-1.055, P=0.004). BAR exhibited an AUC of 0.741 (95% CI: 0.688-0.793, P<0.001) when used to predict patient mortality risk, with 5.27 being the optimal BAR cut-off. Conclusion:We found that BAR can be used as a reliable biomarker to predict mortality in patients with sepsis.

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Section: Discussionmentioning

confidence: 99%

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis

Han¹,

Cheng²,

Liao³

et al. 2022

JIR

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“…Previous studies showed that implementing sepsis alerts in EDs improved compliance with the SSC 2018 bundle and improved survival [ 21 , 22 ]. Song et al utilized only the sepsis-3 criteria as a screening tool both pre-and post-implementation of sepsis alerts.…”

Section: Discussionmentioning

confidence: 99%

The Ramathibodi early warning score as a sepsis screening tool does not reduce the timing of antibiotic administration

et al. 2022

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Background Administration of antibiotics to septic patients within 1 h was recommended in 2018 by the Surviving Sepsis Campaign (SSC) as a strategy to improve survival outcomes. The use of sepsis screening tools in emergency departments (EDs) is important for early diagnosis and initiation of sepsis care. This study aimed to assess the impact of the Ramathibodi early warning score (REWs) on the administration of antibiotics within 1 h of presentation. Methods This was an observational retrospective cohort study with propensity score matching between the sepsis-3 criteria (pre-period) and the REWs (post-period) as screening tools in adult patients with sepsis in EDs. The primary outcome was the proportion of receiving antibiotics within 1 h of presentation in the pre- and post-periods. Results A total of 476 patients were analyzed without propensity matching. The proportion of antibiotic administration within 1 h was higher in patients screened using the REWs compared with standard of care in the total study population (79.5% vs. 61.4%, p < 0.001). After propensity score matching, 153 patients were included in both groups. The proportion of antibiotic administration within 1 h was similar in patients screened using the REWs and those receiving standard of care (79.7% vs. 80.4%, p = 0.886). However, time to intensive care unit (ICU) admission was faster in patients screened using the REWs. Delays in receiving antibiotics of longer than 3 h were associated with increased mortality (adjusted hazard ratio 7.04, 95% confidence interval 1.45 to 34.11, p = 0.015). Conclusions Implementing the REWs as a tool in sepsis screening protocols in EDs did not improve rates of antibiotic administration within 1 h as recommended by the SSC. However, time to ICU admission was improved after implementation of the REWs.

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“…Simplified systems that aid the rapid implementation of recommendations, such as the “Sepsis Six” (United Kingdom), have had notable contributions to the improvement of clinical outcomes (e.g., reduced the number of ICU admissions, hospital length of stay, and in-hospital mortality [ 6 ]. In a previous study performed in our geographical area, improved clinical outcomes were observed among patients who were managed following the activation of the Sepsis Code protocol in the emergency department [ 7 ]. In the present study, only two-thirds of participating centers currently implement Sepsis Code in their institutional protocols, and 40% of activations involve all the interventions recommended in the sepsis bundles ( Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

Time to decision in sepsis

Ferrer¹,

Castillo²,

Martínez-Martínez³

et al. 2022

Rev Esp Quimioter

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Introduction. This study aimed to identify the common barriers leading to delayed initial management, microbiological diagnosis, and appropriate empirical antimicrobial treatment in sepsis. Patients and methods. A cross-sectional study was performed by the application of a population-based survey. Four different surveys were designed, targeting the healthcare personnel located in main hospital areas [emergency department (SEMES); infectious diseases and clinical microbiology-microbiological diagnosis (SEIMC-M); intensive care and infectious diseases, (SEMICYUC-GTEIS); and infectious diseases and clinical microbiology-clinical diagnosis, (SEIMC-C)]. Results. A total of 700 valid surveys were collected from June to November 2019: 380 (54.3%) of SEMES, 127 (18.1%) of SEIMC-M, 97 (13.9%) de SEMICYUC-GTEIS and 96 (13.7%) of SEIMC-C, in 270 hospitals of all levels of care. The qSOFA score was used as a screening tool. The most used biomarker was procalcitonin (n=92, 39.8%). The sepsis code was implemented in 157 of 235 participating centers (66.2%), particularly in tertiary level hospitals. The mean frequency of contaminated blood cultures was 8.9% (8.7). In 85 (78.7%) centers, positive results of blood cultures were available within the first 72 hours and were communicated to the treating physician effectively by phone or e-mail in 76 (81.7%) cases. The main reason for escalating treatment was clinical deterioration, and the reason for de-escalating antimicrobials was significantly different between the specialties. Quality indicators were not frequently monitored among the different participating centers. Conclusion. There are significant barriers that hinder adequate management processes in sepsis in Spanish hospitals.

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Activation of code sepsis in the emergency department is associated with a decrease in mortality

Cited by 5 publications

References 14 publications

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis

Analysis of the Value of the Blood Urea Nitrogen to Albumin Ratio as a Predictor of Mortality in Patients with Sepsis

The Ramathibodi early warning score as a sepsis screening tool does not reduce the timing of antibiotic administration

Time to decision in sepsis

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