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{
    "pk": 10793,
    "title": "A Sepsis-related Diagnosis Impacts Interventions and Predicts Outcomes for Emergency Patients with Severe Sepsis",
    "subtitle": null,
    "abstract": "Introduction:\n Many patients meeting criteria for severe sepsis are not given a sepsis-relateddiagnosis by emergency physicians (EP). This study 1) compares emergency department (ED)interventions and in-hospital outcomes among patients with severe sepsis, based on the presenceor absence of sepsis-related diagnosis, and 2) assesses how adverse outcomes relate to three-hoursepsis bundle completion among patients fulfilling severe sepsis criteria but not given a sepsisrelateddiagnosis.\nMethods:\n We performed a retrospective cohort study using patients meeting criteria for severesepsis at two urban, academic tertiary care centers from March 2015 through May 2015. Weincluded all ED patients with the following: 1) the 1992 Consensus definition of severe sepsis,including two or more systemic inflammatory response syndrome criteria and evidence of organdysfunction; or 2) physician diagnosis of severe sepsis or septic shock. We excluded patientstransferred to or from another hospital and those <18 years old. Patients with an EP-assignedsepsis diagnosis created the “Physician Diagnosis” group; the remaining patients composed the“Consensus Criteria” group. The primary outcome was in-hospital mortality. Secondary outcomesincluded completed elements of the current three-hour sepsis bundle; non-elective intubation;vasopressor administration; intensive care unit (ICU) admission from the ED; and transfer to theICU in < 24 hours. We compared proportions of each outcome between groups using the chi-squaretest, and we also performed a stratified analysis using chi square to assess the association betweenfailure to complete the three-hour bundle and adverse outcomes in each group.\nResults:\n Of 418 patients identified with severe sepsis we excluded 54, leaving 364 patients foranalysis: 121 “Physician Diagnosis” and 243 “Consensus Criteria.” The “Physician Diagnosis” grouphad a higher in-hospital mortality (12.4% vs 3.3%, P < 0.01) and compliance with the three-hour sepsisbundle (52.1% vs 20.2%, P < 0.01) compared with the “Consensus Criteria” group. An incompletethree-hour sepsis bundle was not associated with a higher incidence of death, intubation, vasopressoruse, ICU admission or transfer to the ICU in <24 hours in patients without a sepsis diagnosis.\nConclusion:\n “Physician Diagnosis” patients more frequently received sepsis-specific interventionsand had a higher incidence of mortality. “Consensus Criteria” patients had infrequent adverseoutcomes regardless of three-hour bundle compliance. EPs’ sepsis diagnoses reflect riskstratificationbeyond the severe sepsis criteria.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Severe Sepsis"
        },
        {
            "word": "sepsis"
        },
        {
            "word": "bundled care"
        },
        {
            "word": "Diagnosis"
        }
    ],
    "section": "Patient Safety",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9975s2fs",
    "frozenauthors": [
        {
            "first_name": "Mitchell",
            "middle_name": "",
            "last_name": "Kim",
            "name_suffix": "",
            "institution": "University of Washington, Division of Emergency Medicine, Seattle, Washington",
            "department": "None"
        },
        {
            "first_name": "Taketo",
            "middle_name": "",
            "last_name": "Watase",
            "name_suffix": "",
            "institution": "University of Washington, Division of Emergency Medicine, Seattle, Washington",
            "department": "None"
        },
        {
            "first_name": "Karl",
            "middle_name": "D.",
            "last_name": "Jablonowski",
            "name_suffix": "",
            "institution": "University of Washington, Division of Emergency Medicine, Seattle, Washington",
            "department": "None"
        },
        {
            "first_name": "Medley",
            "middle_name": "O.",
            "last_name": "Gatewood",
            "name_suffix": "",
            "institution": "University of Washington, Division of Emergency Medicine, Seattle, Washington",
            "department": "None"
        },
        {
            "first_name": "Daniel",
            "middle_name": "J.",
            "last_name": "Henning",
            "name_suffix": "",
            "institution": "University of Washington, Division of Emergency Medicine, Seattle, Washington",
            "department": "None"
        }
    ],
    "date_submitted": "2017-05-05T23:58:46Z",
    "date_accepted": "2017-05-05T23:58:46Z",
    "date_published": "2017-09-26T07:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/10793/galley/5875/download/"
        }
    ]
}