Tae Gun Shin1, Sung Yeon Hwang1, Gu Hyun Kang2, Won Young Kim3, Seung Mok Ryoo3, Kyuseok Kim4, You Hwan Jo4, Sung Phil Chung5, Young Seon Joo5, Jin Ho Beom5, Sung-Hyuk Choi6, Young Hoon Yoon6, Woon Yong Kwon7, Tae Ho Lim8, Kap Su Han9, Han Sung Choi10, Gil Joon Suh7. 1. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 2. Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea. 3. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 4. Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 5. Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. 6. Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Korea. 7. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. 8. Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea. 9. Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea. 10. Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea.
Abstract
OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. RESULTS: A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. CONCLUSION: This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shock patients in the ED.
OBJECTIVE: To evaluate the clinical characteristics, therapeutic interventions, and outcomes of patients with septic shock admitted to the emergency department (ED). METHODS: This study was a preliminary, descriptive analysis of a prospective, multi-center, observational registry of the EDs of 10 hospitals participating in the Korean Shock Society. Patients aged 19 years or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion were included. RESULTS: A total of 468 patients were enrolled (median age, 71.3 years; male, 55.1%; refractory hypotension, 82.9%; hyperlactatemia without hypotension, 17.1%). Respiratory infection was the most common source of infection (31.0%). The median Sepsis-related Organ Failure Assessment score was 7.5. The sepsis bundle compliance was 91.2% for lactate measurement, 70.3% for blood culture, 68.4% for antibiotic administration, 80.3% for fluid resuscitation, 97.8% for vasopressor application, 68.0% for central venous pressure measurement, 22.0% for central venous oxygen saturation measurement, and 59.2% for repeated lactate measurement. Among patients who underwent interventions for source control (n=117, 25.1%), 43 (36.8%) received interventions within 12 hours of ED arrival. The in-hospital, 28-day, and 90-day mortality rates were 22.9%, 21.8%, and 27.1%, respectively. The median ED and hospital lengths of stay were 6.8 hours and 12 days, respectively. CONCLUSION: This preliminary report revealed a mortality of over 20% in patients with septic shock, which suggests that there are areas for improvement in terms of the quality of initial resuscitation and outcomes of septic shockpatients in the ED.
Entities:
Keywords:
Mortality; Patient care bundles; Sepsis; Septic shock
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