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01.12.2016 | Original research | Ausgabe 1/2016 Open Access

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Longer time to antibiotics and higher mortality among septic patients with non-specific presentations -a cross sectional study of Emergency Department patients indicating that a screening tool may improve identification

Zeitschrift:
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine > Ausgabe 1/2016
Autoren:
Ulrika Margareta Wallgren, Viktor Erik Antonsson, Maaret Kaarina Castrén, Lisa Kurland
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

UW is responsible for the literature search, data acquisition, analysis and interpretation of the data and the writing of the manuscript. VA contributed to data acquisition and drafting of the manuscript. MC has contributed to the critical revision of the manuscript for important intellectual content. LK has contributed to the study concept and design, to the interpretation of the data, the drafting of the manuscript and to a critical revision of the manuscript for important intellectual content. All authors have read and approved the final manuscript.

Abstract

Background

The presentation of sepsis is varied and our hypotheses were that septic patients with non-specific presentations such as decreased general condition (DGC) have a less favourable outcome, and that a screening tool could increase identification of these patients. We aimed to: 1) assess time to antibiotics and in-hospital mortality among septic patients with ED chief complaint DGC, as compared with septic patients with other ED chief complaints, and 2) determine whether a screening tool could improve identification of septic patients with non-specific presentations such as DGC.

Methods

Cross sectional study comparing time to antibiotics (Mann Whitney and Kaplan-Meier tests), and in-hospital mortality (logistic regression), between 61 septic patients with ED chief complaint DGC and 516 septic patients with other ED chief complaints. The sensitivity and specificity of the modified Robson screening tool was compared with that of ED doctor clinical judgment (McNemar’s two related samples test) among 122 patients presenting to the ED with chief complaint DGC, of which 61 were discharged with ICD code sepsis.

Results

Septic patients presenting to the ED with the chief complaint DGC had a longer median time to antibiotics (05:26 h:minutes; IQR 4:00–10:40, vs. 03:56 h:minutes; IQR 2:21–7:32) and an increased in-hospital mortality (crude OR = 4.01; 95 % CI, 2.19–7.32), compared to septic patients with other ED chief complaints. This association remained significant when adjusting for sex, age, priority, comorbidity and fulfilment of the Robson score (OR 4.31; 95 % CI, 2.12–8.77). The modified Robson screening tool had a higher sensitivity (63.0 vs. 24.6 %, p < 0.001), but a lower specificity (68.3 vs. 100.0 %, p < 0.001), as compared to clinical judgment.

Discussion

This is, to the best of our knowledge, the first study comparing outcome of septic patients according to ED chief complaint. Septic patients presenting with a non-specific ED presentation, here exemplified as the chief complaint DGC, have a less favourable outcome. Our results indicate that implementation of a screening tool may increase the identification of septic patients.

Conclusions

The results indicate that septic patients presenting with ED chief complaint DGC constitute a vulnerable patient group with delayed time to antibiotics and high in-hospital mortality. Furthermore, the results support that implementation of a screening tool may be beneficial to improve identification of these patients.
Literatur
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