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Multicenter Study
. 2017 Aug 30;17(1):27.
doi: 10.1186/s12873-017-0133-6.

Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals

Philippe Le Conte  1 , Séverin Thibergien  2 , Jean Batiste Obellianne  3 , Emmanuel Montassier  2 , Gilles Potel  2 , Pierre Marie Roy  3 , Eric Batard  2
Affiliations
Multicenter Study

Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals

Philippe Le Conte et al. BMC Emerg Med. .

Abstract

Background: Sepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described. The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population.

Methods: In accordance with STROBE statement, we performed a retrospective study in two French University Hospital Emergency Departments from February to August 2015. Patients admitted during the study period were screened using the electronic files of the hospital databases. Patient's files were reviewed and included in the study if they met severe sepsis criteria. Demographics, comorbities, treatments were recorded. Delays from admission to severe sepsis diagnosis, fluid loading onset and antibiotics administration were calculated.

Results: One hundred thirty patients were included (76 men, mean age 71 ± 14 years). Blood culture, lactate dosage, antibiotics and 30 ml/kg fluid loading were performed within 3 hours in % [95% confidence interval] 100% [96-100%], 62% [54-70%], 49% [41-58%] and 19% [13-27%], respectively. 25 patients out of 130 (19% [13-27%]) fulfilled each criteria of the 3-h bundle. The mean fluid loading volume was 18 ± 11 ml/kg. Mean delay between presentation and severe sepsis diagnosis was 200 ± 263 min, from diagnosis to fluid challenge and first antibiotic dose, 10 ± 27 min and 20 ± 55 min, respectively.

Conclusion: Compliance with SSC 3-h bundle and delay between admission and sepsis recognition have to be improved. If confirmed by other studies, an improvement program might be deployed.

Keywords: Bundles; Emergency medicine; Fluid loading; Recognition; Severe sepsis; Surviving sepsis campaign.

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Conflict of interest statement

Ethics approval and consent to participate

According to the French legislation (articles L.1121-1 paragraph 1 and R1121-2, Public health code), the approval of the ethics committee was not needed to use anonymous data for retrospective observational study. Furthermore, same articles stated that ethic approval was not needed to access to hospital databases by medical investigators for a research purpose.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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