The Presentation, Pace, and Profile of Infection and Sepsis Patients Hospitalized Through the Emergency Department: An Exploratory Analysis

Vincent, Jean‐Louis; Bhimarao, Meghana; Greene, J; Manickam, R.; Martínez, Adriana; Schuler, Alejandro; Barreda, Fernando; Escobar, Gabriel J.

doi:10.1097/cce.0000000000000344

Cited by 19 publications

(19 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The variation in antibiotic timing observed across individual patients and the specific factors associated with faster delivery are generally consistent with a risk-based approach to antibiotic prescribing. 33,34 However, time-to-antibiotics was faster for patients with fever and normal blood pressure than for patients without fever but with hypotension, suggesting that obvious signs of infection are a stronger trigger to prescribe antibiotics than shock or that competing treatments for patients with hypotension (eg, starting vasopressors) are prioritized before antibiotics, even though antibiotic delays are associated with greater mortality risk in patients with shock or hypotension. 9,10 Although time-to-antibiotics differed according to patient characteristics, change over time was similar across patient subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…Time-to-antibiotics was defined by order time plus 45 minutes in 51 086 patients (45.9%), ED-to-hospital transfer time in 16 943 patients (15.2%), and BCMA time in 43,356 patients (38.9%) (8489 patients [7.6%] in the ED; 34 867 patients [31.3%] on the wards). Among 8489 patients (7.6%) of patients with BCMA data in the ED, the median (IQR) time from order to administration was 23 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) minutes. A total of 7574 patients (6.8%) died in the hospital, and 13 855 patients (12.4%) died within 30 days of discharge.…”

Section: Study Cohortmentioning

confidence: 99%

See 1 more Smart Citation

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

et al. 2021

Self Cite

View full text Add to dashboard Cite

IMPORTANCE It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives. OBJECTIVE To examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study included 130 VA hospitals from 2013 to 2018. Participants included all patients admitted to the hospital via the emergency department with sepsis from 2013 to 2018, using a definition adapted from the Centers for Disease Control and Prevention Adult Sepsis Event definition, which requires evidence of suspected infection, acute organ dysfunction, and systemic antimicrobial therapy within 12 hours of presentation. Data were analyzed from October 6, 2020, to July 1, 2021.EXPOSURES Time from presentation to antibiotic administration. MAIN OUTCOMES AND MEASURESThe main outcome was differences in time-to-antibiotics across study periods, hospitals, and patient subgroups defined by presenting temperature and blood pressure. Temporal trends in time-to-antibiotics were measured overall and by subgroups. Hospitallevel variation in time-to-antibiotics was quantified after adjusting for differences in patient characteristics using multilevel linear regression models.RESULTS A total of 111 385 hospitalizations for sepsis were identified, including 107 547 men (96.6%) men and 3838 women (3.4%) with a median (interquartile range [IQR]) age of 68 (62-77) years. A total of 7574 patients (6.8%) died in the hospital, and 13 855 patients (12.4%) died within 30 days. Median (IQR) time-to-antibiotics was 3.9 (2.4-6.5) hours but differed by presenting characteristics. Unadjusted median (IQR) time-to-antibiotics decreased over time, from 4.5 (2.7-7.1) hours during 2013 to 2014 to 3.5 (2.2-5.9) hours during 2017 to 2018 (P < .001). In multilevel models adjusted for patient characteristics, median time-to-antibiotics declined by 9.0 (95% CI, 8.8-9.2) minutes per calendar year. Temporal trends in time-to-antibiotics were similar across patient subgroups, but hospitals with faster baseline time-to-antibiotics had less change over time, with hospitals in the slowest tertile decreasing time-to-antibiotics by 16.6 minutes (23.1%) per year, while hospitals in the fastest tertile decreased time-to-antibiotics by 7.2 minutes (13.1%) per year. In the most recent years (2017)(2018), median time-to-antibiotics ranged from 3.1 to 6.7 hours across hospitals (after adjustment for patient characteristics), 6.8% of variation in time-to-antibiotics was explained at the hospital level, and odds of receiving antibiotics within 3 hours increased by 65% (95% CI, 56%-77%) for the median patient if moving to a hospital with faster time-to-antibiotics.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Study Cohortmentioning

confidence: 99%

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Early and accurate recognition of infections is therefore crucial to improve prognosis [ 2 , 3 ]. Diagnosis of infection remains challenging since its clinical presentation is highly variable, currently available biological markers lack specificity and conventional microbiology typically requires 48–72 h to provide definite bacterial documentation [ 4 , 5 ]. Accordingly, an additional yet simple biological marker would be of clinical value to help the front-line emergency physician efficiently screen patients for a potential underlying infection when presenting to the ED with undifferentiated symptoms.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of infections in non-COVID-19 patients admitted to the Emergency Department with severe lymphopenia

et al. 2022

View full text Add to dashboard Cite

Background In the Emergency Department (ED), early and accurate recognition of infection is crucial to prompt antibiotic therapy but the initial presentation of patients is variable and poorly characterized. Lymphopenia is commonly associated with bacteraemia and poor outcome in intensive care unit patients. The objective of this retrospective study was to assess the prevalence of community-acquired infection in a cohort of unselected patients admitted to the ED with undifferentiated symptoms and severe lymphopenia. Methods This is a retrospective single-center study conducted over a 1 year-period before the COVID-19 pandemic. Consecutive adult patients admitted to the ED with severe lymphopenia (lymphocyte count < 0.5 G/L) were studied. Patients with hematological or oncological diseases, HIV infection, hepato-cellular deficiency, immunosuppression, or patients over 85 years old were excluded. Diagnoses of infection were validated by an independent adjudication committee. The association between various parameters and infection was assessed using a multivariate logistic regression analysis. Results Of 953 patients admitted to the ED with severe lymphopenia, 245 were studied (148 men; mean age: 63 ± 19 years). Infection was confirmed in 159 patients (65%) (bacterial: 60%, viral: 30%, other: 10%). Only 61 patients (25%) were referred to the ED for a suspected infection. In the univariate analysis, SIRS criteria (OR: 5.39; 95%CI: 3.04–9.70; p < 0.001) and temperature ≥ 38.3 °C (OR: 10.95; 95%CI: 5.39–22.26; p < 0.001) were strongly associate with infection. In the multivariate analysis, only SIRS criteria (OR: 2.4; 95%CI: 1.48–3.9; p < 0.01) and fever (OR: 3.35; 95%CI: 1.26–8.93; p = 0.016) were independently associated with infection. Conclusions The prevalence of underlying infection is high in patients admitted to the ED with lymphopenia, irrespective of the reason for admission. Whether lymphopenia could constitute a valuable marker of underlying infection in this clinical setting remains to be confirmed prospectively in larger cohorts. Trial registration: No registration required as this is a retrospective study.

show abstract

“…Early diagnosis and appropriate management of sepsis is a major challenge for emergency physicians 9 . According to the third international consensus on sepsis definition, combined use of sequential organ failure assessment (SOFA) and the quick-SOFA (qSOFA) scores are helpful in the early identification of sepsis 1 .…”

Section: Introductionmentioning

confidence: 99%

“…PCT is an infectious disease biomarker that is also effectively used to diagnose sepsis and can be used in place of SOFA score in the emergency department 11,12 . Thus, it is very difficult to use the appropriate score for early diagnosis of sepsis, its severity, prognosis, and risk of mortality in an emergency [9][10][11][12] . Therefore, there is always a need for new diagnostic approaches for the early diagnosis of sepsis and predicting the risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

Combined accuracy of Procalcitonin and Quick Sequential Organ Failure Assessment (qSOFA) in predicting 3-days in-hospital mortality in suspected sepsis.

Memon

Butt

Khalid

et al. 2021

Int. j. endorsing health sci. res.

View full text Add to dashboard Cite

Background: Early identification of sepsis is important for initiating appropriate treatment for decreasing the risk of in-hospital mortality. To determine the diagnostic accuracy of procalcitonin (PCT) and quick sequential organ failure assessment (qSOFA) in predicting 3-days in-hospital mortality in suspected sepsis. Methodology: A cohort study was conducted at the emergency department of Ziauddin University Hospital, Karachi. One-hundred and thirty-two suspected cases of sepsis having age 18-75 years were selected through convenience sampling. PCT level and qSOFA score were obtained for predicting 3-days in-hospital mortality. Results: Of the study patient, 50.8% were male, and 49.2% were female, with a mean age of 53.7 ± 18.3 years. The mean qSOFA score was 1.8 ± 0.5, and the mean PCT level was 2.7 ± 12.5 ng/ml. The combined QSOFA and PCT 3-days in-hospital mortality prediction was 31.1%, while the actual mortality rate was 28.0%. The combined qSOFA score and PCT level sensitivity was 62.2%, specificity 81.1%, positive predicted value 56.1%, negative predicted value 84.7%, and diagnostic accuracy 75.8%. Conclusion: The combined use of QSOFA and PCT improves the 3-day in-hospital mortality prediction in suspected cases of sepsis.

show abstract

The Presentation, Pace, and Profile of Infection and Sepsis Patients Hospitalized Through the Emergency Department: An Exploratory Analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 19 publications

References 45 publications

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis

High prevalence of infections in non-COVID-19 patients admitted to the Emergency Department with severe lymphopenia

Combined accuracy of Procalcitonin and Quick Sequential Organ Failure Assessment (qSOFA) in predicting 3-days in-hospital mortality in suspected sepsis.

Contact Info

Product

Resources

About