Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock*

Pruinelli, Lisiane; Westra, Bonnie L.; Yadav, Pranjul; Hoff, Alexander; Steinbach, Michael; Kumar, Vipin; Delaney, Connie W; Simon, György

doi:10.1097/ccm.0000000000002949

Cited by 147 publications

(107 citation statements)

References 31 publications

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“…The increased difference in TTK compared to TTI may partly be explained by the fact that the alarm of the incubator is immediately recognized by the ICU staff with on-site culturing, while additional information of the microbiologist to the clinician is required with external culturing. The relevance of this finding is emphasized by reports suggesting that mortality in patients with septic shock increases every hour with delayed effective antibiotic treatment [12,30]. It needs to be considered that the initial empirical antibiotic therapy is ineffective in 20-30% of all patients [12,31].…”

Section: Discussionmentioning

confidence: 95%

On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients

et al. 2019

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Section: Discussionmentioning

confidence: 95%

On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients

et al. 2019

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“…Other reasons might be the lack of a trauma system and intensive care unit, and distance to the hospital and lack of a rapid transport by ambulances, leading to late presentation. Delayed presentation has been shown to be associated with a poor outcome in sepsis, trauma and pregnancy-related problems [44][45][46][47], and might have outweighed the benefit of an emergency department.…”

Section: Discussionmentioning

confidence: 99%

Diagnoses made in an Emergency Department in rural sub-Saharan Africa

et al. 2019

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BACKGROUND: Information on diagnoses made in emergency departments situated in rural sub-Saharan Africa is scarce. The aim was: to evaluate the frequency of different diagnoses made in a new emergency department to define relevant healthcare requirements; and to find out if in-hospital mortality rates would decrease after the implementation of the emergency department.METHODS: In this observational study, we prospectively collated diagnoses of all patients presenting to the emergency department of the St Francis Referral Hospital in Ifakara, Tanzania during 1 year. In addition, we compared in-hospital mortality rates before and after the implementation of the emergency department.RESULTS: From July 2016 through to June 2017, a total of 35,903 patients were included. The median age was 33.6 years (range 1 day to 100 years), 57% were female, 25% were children <5 years, 4% were pregnant and 9% were hospitalised. The most common diagnoses were respiratory tract infection (12.6%), urinary tract infection (11.4%), trauma (9.8%), undifferentiated febrile illness (5.4%), and malaria (5.2%). The most common clinical diagnoses per age group were: lower respiratory tract infection (16.1%) in children <5 years old; trauma (21.6%) in 5-to 17-year-olds; urinary tract infection (13.5%) in 18-to 50-year-olds; and hypertensive emergency (12.4%) in >50-year-olds. Respiratory tract infections peaked in April during the rainy season, whereas malaria peaked 3 months after the rainy season. In-hospital mortality rates did not decrease during the study period (5.6% in 2015 vs 7.6% in 2017).CONCLUSIONS: The majority of diagnosed disorders were of infectious or traumatic origin. The majority of febrile illnesses were poorly defined because of the lack of diagnostic methods. Trauma systems and inexpensive accurate diagnostic methods for febrile illnesses are needed in rural sub-Saharan Africa.

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“…While evidence supporting the efficacy of specific 3-hour bundle elements remains unsettled, 19 a wealth of literature demonstrates a correlation between bundle uptake and decreased sepsis mortality, especially for early antibiotic administration. 13,[20][21][22][23][24][25][26] Some analysis suggests that differing initial resuscitation practices explain different mortality rates in the early goal-directed therapy trials. 27 The comparatively poor performance for non-ICU HPS indicates further QI efforts are better focused on inpatient wards, rather than on EDs or ICUs where resuscitation is already delivered with substantially greater fidelity.…”

Section: Discussionmentioning

confidence: 99%

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

Leisman

Angel

Schneider

et al. 2019

Journal of Hospital Medicine

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epsis is both the most expensive condition treated and the most common cause of death in hospitals in the United States. [1][2][3] Most sepsis patients (as many as 80% to 90%) meet sepsis criteria on hospital arrival, but mortality and costs are higher when meeting criteria after admission. [3][4][5][6] Mechanisms of this increased mortality for these distinct populations are not well explored. Patients who present septic in the emergency department (ED) and patients who present as inpatients likely present very different challenges for recognition, treatment, and monitoring. 7 Yet, how these groups differ by demographic and clinical characteristics, the etiology and severity of infection, and patterns of resuscitation care are not well described. Literature on sepsis epidemiology on hospital wards is particularly limited. 8 This knowledge gap is important. If hospital-presenting sepsis (HPS) contributes disproportionately to disease burd-CHFens, it reflects a high-yield population deserving the focus of quality improvement (QI) initiatives. If specific causes of disparities were identified-eg, poor initial resuscitation-they could be specifically targeted for correction. Given that current treatment guidelines are uniform for the two populations, 9,10 characterizing phenotypic differences could also have implications for both diagnostic and therapeutic recommendations, particularly if the groups display substantially differing clinical

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Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock*

Cited by 147 publications

References 31 publications

On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients

On-site blood culture incubation shortens the time to knowledge of positivity and microbiological results in septic patients

Diagnoses made in an Emergency Department in rural sub-Saharan Africa

Sepsis Presenting in Hospitals versus Emergency Departments: Demographic, Resuscitation, and Outcome Patterns in a Multicenter Retrospective Cohort

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