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Observational Study
. 2015 Feb;30(1):78-84.
doi: 10.1016/j.jcrc.2014.07.012. Epub 2014 Jul 22.

Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards

Stacey-Ann Whittaker  1 , Barry D Fuchs  2 , David F Gaieski  3 , Jason D Christie  4 , Munish Goyal  5 , Nuala J Meyer  2 , Craig Kean  6 , Dylan S Small  7 , Scarlett L Bellamy  3 , Mark E Mikkelsen  8
Affiliations
Observational Study

Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards

Stacey-Ann Whittaker et al. J Crit Care. 2015 Feb.

Abstract

Purpose: The purpose of this study was to detail the trajectory and outcomes of patients with severe sepsis admitted from the emergency department to a non-intensive care unit (ICU) setting and identify risk factors associated with adverse outcomes.

Material and methods: This was a single-center retrospective cohort study conducted at a tertiary, academic hospital in the United States between 2005 and 2009. The primary outcome was a composite outcome of ICU transfer within 48 hours of admission and/or 28-day mortality.

Results: Of 1853 patients admitted with severe sepsis, 841 (45%) were admitted to a non-ICU setting, the rate increased over time (P < .001), and 12.5% of these patients were transferred to the ICU within 48 hours and/or died within 28 days. In multivariable models, age (P < .001), an oncology diagnosis (P < .001), and illness severity as measured by Acute Physiologic and Chronic Health Evaluation II (P = .04) and high (≥4 mmol/L) initial serum lactate levels (P = .005) were associated with the primary outcome.

Conclusions: Patients presenting to the emergency department with severe sepsis were frequently admitted to a non-ICU setting, and the rate increased over time. Of 8 patients admitted to the hospital ward, one was transferred to the ICU within 48 hours and/or died within 28 days of admission. Factors present at admission were identified that were associated with adverse outcomes.

Keywords: ICU transfer; Infection; Mortality; Outcomes; Severe sepsis.

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Conflict of interest statement

Disclosures: For each of the above authors, no financial or other potential conflicts of interest exist related to the work. Presented as an abstract, in part, at the Society of Critical Care Medicine Congress in San Diego, CA in 2011.

Figures

Figure 1
Figure 1
Flow diagram of triage and disposition status of the cohort of patients admitted from the emergency department with severe sepsis. * Discharged home group included 181 subjects discharged home with home health care and 6 subjects who left against medical advice. † Discharged to skilled care facility group included subjects discharged to acute rehabilitation facilities (N=16), skilled nursing facilities (N=100), and other facilities (N=27).
Figure 2
Figure 2
Timing of intensive care unit transfer during hospital stay in patients with severe sepsis admitted from the emergency department to the hospital ward.
See this image and copyright information in PMC

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