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GEORGETOWN, TX – Severe sepsis patients stabilized in the emergency department instead of immediately triaged to a hospital’s intensive care unit had no increased risk of mortality, according to a new study.
Those findings were based on a retrospective chart review by a research team from Baylor Scott & White Health and Texas A&M Health Science Center College of Medicine. The research was presented recently at the CHEST Annual Meeting 2015 in Montreal.
The analysis indicates that sicker patients were triaged quickly to the ICU and had a shorter ED length of stay. When the researchers looked at additional variables that could impact mortality in severe sepsis – ED triage to antibiotic time, triage to lactate time, lactate clearance, ED length of stay, and variations in volume of IV fluids – no significant differences were found between the ED vs. the ICU, except initial lactate value and shorter lengths-of-stay (LOS) in the ED. Study authors note that both of those variables indicate sicker patients and were linked to higher mortality rates.
"Our study found that the sickest patients were more quickly triaged to the ICU. Those patients who were less sick and kept in the ED for longer time had lower mortality," lead researcher Aruna Jahoor, MD, of Baylor Scott & White Health Central Division, said. “These results suggest that identification and immediate treatment may positively impact survival in sepsis – no matter the hospital location of that patient."
For the study, the researchers looked at consecutive adult patients admitted with severe sepsis from the ED to the ICU from 2010-13. Results indicate that the 164 patients with severe sepsis had an in-hospital mortality rate of 26.8%, a 28-day mortality rate of 32.3%, and a use of invasive mechanical ventilation rate of 45.1%.
Compared to those who were in the ED less than six hours, sepsis patients in the ED for six hours or longer had significantly better outcomes for in-hospital mortality –relative risk of 1.86 –and 28-day mortality –relative risk of 1.79.
“We determined that a shorter ED LOS identified sicker patients at higher risk of mortality,” the authors write. “Spending a longer time in the ED was not associated with adverse outcomes.”
Therefore, the researchers suggest, “septic patients may be stabilized in an ED setting without risk of increased mortality from delayed ICU admission.” They caution, however, that their study was limited by a small sample size in a single institution.
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