Delays From First Medical Contact to Antibiotic Administration for Sepsis

Abstract

Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.

Design: Retrospective cohort study.

Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.

Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital.

Measurements and main results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7-8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40-0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1-7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00-1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).

Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.

Figure 1

Delays in antibiotic administration in sepsis. ED = emergency department.

Figure 2

Patient accrual. EMS = emergency medical services.

Figure 3

Association between medical contact delay and in-hospital mortality in community-acquired sepsis. The Surviving Sepsis campaign (SSC) criteria for organ dysfunction that were measurable in our electronic health record extract included: hypotension (SBP, ≤ 90 mm Hg), lactate greater than or equal to 2.0 mmol/L, Pao₂/Fio₂ ratio less than or equal to 250, serum creatinine greater than 2.0 mg/dL, total bilirubin greater than 2.0 mg/dL, platelet count less than 100,000 μL, or international normalized ratio greater than 1.5. OR = odds ratio, SBP = systolic blood pressure, SOFA = Sepsis-Related Organ Failure Assessment score.