Frequency and Types of Healthcare Encounters in the Week Preceding a Sepsis Hospitalization: A Systematic Review

Abstract

OBJECTIVES: Early recognition and treatment are critical to improving sepsis outcomes. We sought to identify the frequency and types of encounters that patients have with the healthcare system in the week prior to a sepsis hospitalization. DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and the Cochrane Library. STUDY SELECTION: Observational cohort studies of patients hospitalized with sepsis or septic shock that were assessed for an outpatient or emergency department encounter with the healthcare system in the week prior to hospital admission. DATA EXTRACTION: The primary outcome was the proportion of patients with a healthcare encounter in the time period assessed (up to 1 week) prior to a hospitalization with sepsis. DATA SYNTHESIS: Six retrospective observational studies encompassing 6,785,728 sepsis admissions were included for evaluation, ranging from a 263-patient single-center cohort to a large database evaluating 6,731,827 sepsis admissions. The average (unweighted) proportion of patients having an encounter with the healthcare system in the week prior to a sepsis hospitalization was 32.7% and ranged from 10.3% to 52.9%. These encounters commonly involved presentation or potential symptoms of infectious diseases, antibiotic prescriptions, and appeared to increase in frequency closer to a sepsis hospitalization admission. No consistent factors were identified that distinguished a healthcare encounter as more or less likely to precede a sepsis hospitalization in the subsequent week. CONCLUSIONS: Patients that present to the hospital with sepsis are frequently evaluated in the healthcare system in the week prior to admission. Further research is necessary to understand if these encounters offer earlier opportunities for intervention to prevent the transition from infection to sepsis, whether they merely reflect the comorbidities of sepsis patients with a high baseline rate of healthcare encounters, or the declining trajectory of a patient’s overall health in response to infection.

Use of healthcare before and after sepsis in Sweden: a case–control study

“…The proportion was comparable to earlier reported numbers, although only a handful of studies have been made, and all differ slightly in the way healthcare the 7 days prior is defined. 9 Still, a considerable amount of patients with sepsis seek prehospital medical attention. The high rate could reflect a higher comorbidity burden across this patient group, although this was something we tried to adjust for.…”

“…A recent systematic review found on average 33% of patients with sepsis had a healthcare encounter the week prior to sepsis, but the range between studies was big, and the definition of healthcare the week prior varied. 9 …”

Exploring the effects of coronary artery disease as a preexisting comorbidity on mortality in hospitalized septic patients: a retrospective observation study

“…[4] Sepsis also ranks number 1 in hospitalization costs as related cases account for $41.5 billion annually. [5] The average cost of a hospital stay for sepsis is double the cost of a stay for all other conditions. [6] Given the high prevalence and mortality rate of sepsis, it is important for hospitals and other institutions to develop a risk stratification strategy.…”

“…[4] Sepsis also ranks number 1 in hospitalization costs as related cases account for $41.5 billion annually. [5] The average cost of a hospital stay for sepsis is double the cost of a stay for all other conditions. [6]…”