Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands

Wekken, Lena C. W. van der; Alam, Nadia; Holleman, F.; Exter, Pieternel van; Kramer, Mark H. H.; Nanayakkara, Prabath W.B.

doi:10.3109/10903127.2015.1037476

Cited by 34 publications

(26 citation statements)

References 25 publications

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“…Furthermore, some retrospective sepsis studies used sepsis-related ICD coding [26] or the existence of blood cultures to identify cases in retrospect [27, 28]. Of those, only Stoneking et al evaluated if sepsis was explicitly articulated in the patient record or if a sepsis order set was launched [28].…”

Section: Discussionmentioning

confidence: 99%

“…Given that ACCP/SCCM sepsis definitions are fundamentally based on altered vital signs, incomplete documentation suggests a lack of appreciation or maybe even ignorance of sepsis definitions. In a retrospective study from the Netherlands [26] fragmentary collection of vital signs (only 7.6% were documented completely) was associated with rare sepsis recognition (14% of cases). Even though acute patient care is more important than paperwork, poor record keeping may promote underdiagnosis of sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Sepsis recognition in the emergency department – impact on quality of care and outcome?

et al. 2016

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BackgroundAppropriate and timely recognition of sepsis is a prerequisite for starting goal-directed therapy bundles. We analyzed the appropriateness of sepsis recognition and documentation with regard to adequacy of therapy and outcome in an internal medicine emergency department (ED).MethodsThis study included 487 consecutive patients ≥18 years of age who presented to a university hospital ED during a 4-week period. Clinical, laboratory, and follow-up data were acquired independently from documentation by ED physicians. The study team independently rated quality of sepsis classification (American College of Chest Physicians/Society of Critical Care Medicine definitions), diagnostic workup, and guideline-adherent therapy in the ED.ResultsOf 487 included patients, 110 presented because of infection. Of those, 54 patients matched sepsis criteria, including 20 with organ damage and thus severe sepsis, as rated by the study team. Sepsis was not recognized in 32 of these 54 cases (59%). Multivariate binary logistic regression analysis revealed that higher systolic blood pressure (p <0.05), the ability to stand (p <0.01) and a low number of documented vital signs in the ED discharge letter (p < 0.05) were independent predictors of missed sepsis. Surprisingly, adequate detection of the septic focus (81 vs. 93%, p = 0.17), appropriate fluid administration (86 vs. 87%, p = 0.39), and guideline-adherent antibiotic regimen (95 vs. 100%, p = 0.42) did not differ between cases of recognized and unrecognized sepsis, respectively. Non-recognition affected neither death-censored length of hospital stay (median 7.63 d vs. 7.13 d, p = 0.42) nor a combined endpoint of death or ICU admission to (9 vs. 12%, p = 0.55).ConclusionsNon-recognition of sepsis in ED patients with serious infections who formally meet organizational sepsis definitions seems to have no deleterious impact on initial therapy adequacy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-017-0122-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sepsis recognition in the emergency department – impact on quality of care and outcome?

et al. 2016

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“…10 Research in patients transported by ambulance shows that recognition of sepsis in the prehospital setting is low. 11 12 Most patients with sepsis initially contact a general practitioner (GP), and the assessment by the GP, including the decision whether or not to refer a patient to secondary care, is crucial for timely initiation of hospital treatment. Recording of vital signs is essential, but, compared with secondary care doctors, GPs generally use more factors such as clinical impression and gut feeling in their diagnostic work-up.…”

Section: Introductionmentioning

confidence: 99%

Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

et al. 2018

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ObjectivesTimely recognition and treatment of sepsis is essential to reduce mortality and morbidity. Acutely ill patients often consult a general practitioner (GP) as the first healthcare provider. During out-of-hours, GP cooperatives deliver this care in the Netherlands. The aim of this study is to explore the role of these GP cooperatives in the care for patients with sepsis.DesignRetrospective study of patient records from both the hospital and the GP cooperative.SettingAn intensive care unit (ICU) of a general hospital in the Netherlands, and the colocated GP cooperative serving 260 000 inhabitants.ParticipantsWe used data from 263 patients who were admitted to the ICU due to community-acquired sepsis between January 2011 and December 2015.Main outcome measuresContact with the GP cooperative within 72 hours prior to hospital admission, type of contact, delay from the contact until hospital arrival, GP diagnosis, initial vital signs and laboratory values, and hospital mortality.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.7 hours. The GP had not suspected an infection in 43% of the patients. In this group, the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% vs 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in prehospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.

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“…The growing increase in sepsis incidence can be due to various reasons: first, the growing use of chemo-and immunotherapy responsible for immunosuppression in the patients receiving these therapies; second, the rapid surge in the emergence of antibiotic-resistant microorganisms over the past few years; and third, the increase in the percentage of ageing citizens who are at greater risk of sepsis because of the presence of numerous comorbidities [5,8].…”

Section: Introductionmentioning

confidence: 99%

Elevation of NT-proBNP and cardiac troponins in sepsis-related deaths: a forensic perspective

et al. 2016

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In the present study, the levels of NT-proBNP, troponin T, and troponin I were measured in postmortem serum from femoral blood in a series of sepsis-related fatalities that had undergone forensic autopsies. We aimed to assess whether a possible increase in the concentrations of these biomarkers was correlated to macroscopic or microscopic observations that suggest myocardial damage or cardiac dysfunction. Two study groups were retrospectively formed, a sepsis-related fatalities group and a control group. Both groups consisted of 16 forensic autopsy cases. Unenhanced computed tomography scan, autopsy, histological, toxicological, microbiological, and biochemical analyses were performed for all cases in both groups. Levels of procalcitonin, C-reactive protein, NT-proBNP, troponin T, and troponin I were systematically measured in postmortem serum from femoral blood. The preliminary results suggest that the postmortem serum troponin I, troponin T, and NT-proBNP levels are increased in sepsis-related deaths in the absence of any relevant coronary artery disease, myocardial ischemia, or signs of heart failure. These findings corroborate clinical data from previous studies pertaining to the usefulness of troponins and natriuretic peptides as indicators of toxic and inflammatory damage to the heart in cases of severe sepsis and septic shock without concomitant underlying coronary syndromes.

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Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands

Cited by 34 publications

References 25 publications

Sepsis recognition in the emergency department – impact on quality of care and outcome?

Sepsis recognition in the emergency department – impact on quality of care and outcome?

Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

Elevation of NT-proBNP and cardiac troponins in sepsis-related deaths: a forensic perspective

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