Epidemiology, management, and outcome of infection, sepsis, and septic shock in a German emergency department (EpiSEP study)

Abstract

BackgroundThe adjacent conditions infection, sepsis, and septic shock are among the most common causes of treatment in the emergency department (ED). Most available data come from intensive care units (ICU) and include nosocomial infections acquired during hospitalization. Epidemiological data from German EDs are not yet available, although the ED is one of the first points of contact for patients. The aim of this study was to investigate the epidemiology, causes, diagnosis, mortality, and treatment of patients with infections in the ED.Materials and methodsIn this retrospective, single-center observational study, routinely collected data from the patient data management system and from the hospital information system were analyzed. All adult patients who presented to the ED in connection with an infection during the study period from 01/01 to 28/02/2019 were included. Exclusion criteria were age ≤ 17 years and incomplete records. Three groups (I. Infection, II. Sepsis, and III. Septic shock) were defined according to SEPSIS-3 definitions.ResultsDuring the study period, a total of 6,607 patients were treated in the ED. Of these patients, 19.3% (n = 1,278) had an infection (mean age 56 ± 23 years, 50% female). The sites of infection were distributed as follows: Respiratory tract 35%, genitourinary tract 18%, maxillofacial/ears/nose/throat 14%, intraabdominal 13%, soft tissues 10%, central nervous system 1%, other cause 3%, or unknown cause 6%. Infection only, sepsis and septic shock were present in 86, 10, and 3%, respectively. There were significant differences in vital signs as well as in the various emergency sepsis scores across the predefined groups [I vs. II vs. III: SOFA (pts.): 1 ± 1 vs. 4 ± 2 vs. 7 ± 3 (p < 0.0001), systolic blood pressure (mmHg): 137 ± 25 vs. 128 ± 32 vs. 107 ± 34 (p < 0.05), heart rate (bpm): 92 ± 18 vs. 99 ± 23 vs. 113 ± 30 (p < 0.05), respiratory rate (min-1): 18 ± 4 vs. 20 ± 7 vs. 24 ± 10 (p < 0.05)]. In the three groups, blood cultures were obtained in 34, 81, and 86%, of cases, respectively and antibiotics were administered in the ED in 50, 89, and 86%, of cases respectively. The 30-day mortality rate in the three groups was 1.6, 12.0, and 38.1%, respectively.ConclusionThis study is the first to show the incidence, management, and outcome of patients classified as infection, sepsis, and septic shock in a German ED. The findings of our real-world data are important for quality management and enable the optimization of treatment pathways for patients with infectious diseases.

Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China

“…Although a single ophthalmic emergency is rarely life-threatening, delayed treatment may lead to severe vision loss and subsequent poor quality of life. Prior ED studies focused on either general emergency medicine ( 14 , 15 ) or ocular trauma emergencies ( 16 – 18 ), and they were mainly conducted in the United States and other developed countries, with little information from developing countries ( 4 , 18 – 20 ). To our knowledge, no researches have been done on ophthalmic nurses’ preferences for triage and associated risk factors.…”

The Clinical Utility of Albumin with Sequential Organ Failure Assessment (SOFA) in Improving 30-Day Mortality Prediction in Patients with Infection in the Emergency Department

“…While increasing evidence is available on patients with sepsis and their management, there is far less information available on those with a general infectious state. Wolfertz et al recently suggested that an infectious state causes more than one-fifth of ED admissions, and that only a small percentage of them (~15%) are already septic on arrival in the ED [1]. Using the SOFA score to identify patients with sepsis is also emphasized in the most recent guidelines [7].…”

“…Infection-related symptoms are common reasons for admission to the emergency department (ED) [1][2][3][4]. Infectious states are a diverse group of clinical disorders that range from uncomplicated, non-severe infections that may not require evaluation in the ED to serious, often life-threatening conditions with a high risk of poor outcomes [1][2][3][4][5]. Sepsis and septic shock, in particular, are responsible for over 30% of all in-hospital mortality and cause 11 million deaths annually [3,6].…”

“…Sepsis and septic shock, in particular, are responsible for over 30% of all in-hospital mortality and cause 11 million deaths annually [3,6]. Only a few patients with infections who require hospitalization have severe haemodynamic impairment when they arrive in the ED [1,7]. Others appear clinically stable despite persistent microvascular and tissue changes that, if not discovered early, could lead to death [1,7,8].…”

“…Only a few patients with infections who require hospitalization have severe haemodynamic impairment when they arrive in the ED [1,7]. Others appear clinically stable despite persistent microvascular and tissue changes that, if not discovered early, could lead to death [1,7,8].…”