Delayed interhospital transfer of critically ill patients with surgical sepsis

Abstract

Background: Suboptimal triage of critically ill patients with surgical sepsis may contribute to adverse outcomes. Patients transferred to a tertiary care center after spending ≥24 hours at an outside facility were compared with patients who had early triage to a tertiary care center with the null hypothesis that management parameters and outcomes would be similar between groups.Methods: This prospective observational cohort study included 308 patients treated for surgical sepsis in a surgical intensive care unit at a tertiary care center. Patients transferred after spending more than 24 hours at an outside facility (n=69) were compared with patients who were directly admitted or transferred within 24 hours (n=239). Patient characteristics, management parameters, and outcomes were compared between groups. This study was registered at ClinicalTrials.gov ().Results: Average outside facility length of stay in the delayed transfer group was 43 hours. Delayed transfer patients had higher SOFA (7 vs. 5, p=0.003) and APACHE II scores (19 vs. 16, p=0.007) on admission. The interval between admission and source control was significantly longer in the delayed transfer group (12.1 vs. 1.0 hours, p=0.009). The incidence of nosocomial infection was significantly higher in the delayed transfer group (41% vs. 23%, p=0.005). Delayed transfer was independently associated with a 10-day increase in hospital length of stay. Delayed transfer patients were less likely to be discharged home (22% vs. 59%, p<0.001) and suffered twofold higher in-hospital mortality (14.5% vs. 7.1%, p=0.056). Conclusion:Patients with surgical sepsis who spent more than 24 hours at an outside facility prior to transfer had greater initial illness severity, longer intervals between admission and source control, and more nosocomial infections compared with patients who had early triage to a tertiary care center.

Prolonged casualty care: Extrapolating civilian data to the military context

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Is the Critical Care Resuscitation Unit Sustainable: A 5-Year Experience of a Beneficial and Novel Model

“…Critically ill patients with a wide range of complex disease processes often require expeditious transfer to tertiary or quaternary institutions' emergency departments (EDs) and intensive care units (ICUs) for a higher level of care. Decreasing time to definitive care at high-volume centers can improve outcomes in various patient populations, and it is for this reason that in July 2013, the critical care resuscitation unit (CCRU) was established at the University of Maryland Medical Center (UMMC)'s R Adams Cowley Shock Trauma Center (STC) [ 1 – 5 ]. The CCRU was designed to be a multispecialty resuscitation unit that receives both medical and surgical patients, typically from Maryland, Delaware, and Virginia.…”

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“…Установлено, что чем выше степень дисфункции жизненно важных систем пациента, тем в большей мере он подвержен рискам при транспортировке и, соответственно, тем более негативным может быть результат лечения [4][5][6][7]. В доступной литературе мы не встретили сравнительных исследований по выживаемости пациентов, которые, находясь в критическом состоянии, подвергались медицинской эвакуации и в процессе транспортировки получали вазопрессорную поддержку.…”