2013
DOI: 10.1002/jhm.2012
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The epidemiology of acute organ system dysfunction from severe sepsis outside of the intensive care unit

Abstract: Background Severe sepsis is a common, costly, and complex problem, the epidemiology of which has only been well studied in the intensive care unit (ICU). However, nearly half of all patients with severe sepsis are cared for outside the ICU. Objective To determine rates of infection and organ system dysfunction in patients with severe sepsis admitted to non-ICU services Design Retrospective cohort study Setting A large tertiary academic medical center in the United States Patients Adult patients initial… Show more

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Cited by 69 publications
(64 citation statements)
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References 23 publications
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“…There is an increasing evidence that patients are frequently cared in general wards (not considering if appropriate or not) even in the presence of severe sepsis and septic shock. 1,2 Early hemodynamic and respiratory support, along with prompt appropriate antimicrobial therapy and source control of the infectious process are cornerstone management strategies to reduce mortality. 3,4 Antimicrobial therapy should be as much appropriate as possible, since inappropriate initial antimicrobial therapy is associated with poorer outcome in different clinical settings.…”
Section: Introductionmentioning
confidence: 99%
“…There is an increasing evidence that patients are frequently cared in general wards (not considering if appropriate or not) even in the presence of severe sepsis and septic shock. 1,2 Early hemodynamic and respiratory support, along with prompt appropriate antimicrobial therapy and source control of the infectious process are cornerstone management strategies to reduce mortality. 3,4 Antimicrobial therapy should be as much appropriate as possible, since inappropriate initial antimicrobial therapy is associated with poorer outcome in different clinical settings.…”
Section: Introductionmentioning
confidence: 99%
“…First, there is an intense selection bias imparted by the specialized care provided in ICUs, with many patients needing circulatory or respiratory support requiring ICU admission. Second, the specific infections leading to sepsis differ on the wards when compared with the ICU (1,4). Third, patients with sepsis on the wards have different rates and distribution of organ failure (1,4).…”
mentioning
confidence: 98%
“…Second, the specific infections leading to sepsis differ on the wards when compared with the ICU (1,4). Third, patients with sepsis on the wards have different rates and distribution of organ failure (1,4). The widespread improvement efforts of the SSC have helped to reduce overall sepsis mortality (2), regardless of the initial setting of care.…”
mentioning
confidence: 98%
“…Although checklists have been established in critical care, use outside and before admission to the intensive care unit (ICU) is variable (9), especially given that patients often develop respiratory failure and critical illness in other areas of the hospital. From 2001 to 2009, there was a reported 79% increase in ICU admissions from the emergency department (ED) (10), and 14% of adult patients hospitalized outside of the ICU had severe sepsis, with threequarters of these patients having multiorgan failure (11).…”
mentioning
confidence: 99%
“…As such, patients in the ED and on the wards represent a population that would be greatly served by systematic clinical response and treatment to impending respiratory distress (11). Rather than determining care for a patient based upon their location, the use of a checklist based upon the critical illness of a patient would be more patient centric, context appropriate, and reflective of the spectrum of respiratory failure.…”
mentioning
confidence: 99%