Neus Robert Boter1, Josep Maria Mòdol Deltell2, Irma Casas Garcia3, Gemma Rocamora Blanch4, Gemma Lladós Beltran4, Anna Carreres Molas5. 1. Servicio de Urgencias, Hospital Universitario Germans Trias i Pujol, Badalona, España; Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España. Electronic address: neusrobert1982@gmail.com. 2. Servicio de Urgencias, Hospital Universitario Germans Trias i Pujol, Badalona, España; Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España. 3. Servicio de Medicina Preventiva, Hospital Universitario Germans Trias i Pujol, Badalona, España. 4. Servicio de Medicina Interna, Hospital Universitario Germans Trias i Pujol, Badalona, España. 5. Servicio de Urgencias, Hospital Universitario Germans Trias i Pujol, Badalona, España.
Abstract
OBJECTIVES: To evaluate the impact of a code sepsis (CS) activation, complying with recommendations, the evolution of patients with severe sepsis in the emergency room and determine independent factors associated to mortality. METHOD: All patients attending the emergency room with severe sepsis during a 6-month period were included. Complying with Surviving Sepsis Campaign recommendations, patients' average stay, intensive care admissions and 30-day mortality were assessed. Two groups were compared: CS activation (A) and no activation (NA). RESULTS: A total of 114 episodes were found, 61.4% belonging to group A and 38.6% to NA. Patients in group A presented hypotension more frequently (61.5% vs 34.4%; P=.005). Patients in group NA more frequently had lactate levels of >3mmol/L (48.3% vs 80%; P=.01), and abdominal focus of sepsis (34.3% vs 13%; P=.01). In group A, blood cultures were more frequently drawn in the first hour (95% vs 41.7%; P<.001), early antibiotic was administered (76.9% vs 25%; p=.005) and fluid replacement carried out (54.5% vs 18.2%; P=.01). Global achievement of CS objectives was higher in group A (31.4% vs 9.1%; P=.006). In group NA more patients were admitted to the intensive care unit (10% vs 36.4%; P<.001), had longer average stays (10.2 days SD 6.9 vs 14.4 days SD 5.8; P<.001) and a higher mortality rate (4.3% vs 34.1%; P<.001). CRP>200mg/l (OR 33.7; P<.001) and the no activation of CS (OR 13.3; p=.001) resulted in being independent factors associated with mortality. CONCLUSIONS: The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.
OBJECTIVES: To evaluate the impact of a code sepsis (CS) activation, complying with recommendations, the evolution of patients with severe sepsis in the emergency room and determine independent factors associated to mortality. METHOD: All patients attending the emergency room with severe sepsis during a 6-month period were included. Complying with Surviving Sepsis Campaign recommendations, patients' average stay, intensive care admissions and 30-day mortality were assessed. Two groups were compared: CS activation (A) and no activation (NA). RESULTS: A total of 114 episodes were found, 61.4% belonging to group A and 38.6% to NA. Patients in group A presented hypotension more frequently (61.5% vs 34.4%; P=.005). Patients in group NA more frequently had lactate levels of >3mmol/L (48.3% vs 80%; P=.01), and abdominal focus of sepsis (34.3% vs 13%; P=.01). In group A, blood cultures were more frequently drawn in the first hour (95% vs 41.7%; P<.001), early antibiotic was administered (76.9% vs 25%; p=.005) and fluid replacement carried out (54.5% vs 18.2%; P=.01). Global achievement of CS objectives was higher in group A (31.4% vs 9.1%; P=.006). In group NA more patients were admitted to the intensive care unit (10% vs 36.4%; P<.001), had longer average stays (10.2 days SD 6.9 vs 14.4 days SD 5.8; P<.001) and a higher mortality rate (4.3% vs 34.1%; P<.001). CRP>200mg/l (OR 33.7; P<.001) and the no activation of CS (OR 13.3; p=.001) resulted in being independent factors associated with mortality. CONCLUSIONS: The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.
Authors: Elliott D Crouser; Joseph E Parrillo; Greg S Martin; David T Huang; Pierre Hausfater; Ilya Grigorov; Diana Careaga; Tiffany Osborn; Mohamad Hasan; Liliana Tejidor Journal: J Intensive Care Date: 2020-05-05
Authors: F J Candel; M Borges Sá; S Belda; G Bou; J L Del Pozo; O Estrada; R Ferrer; J González Del Castillo; A Julián-Jiménez; I Martín-Loeches; E Maseda; M Matesanz; P Ramírez; J T Ramos; J Rello; B Suberviola; A Suárez de la Rica; P Vidal Journal: Rev Esp Quimioter Date: 2018-06-25 Impact factor: 1.553
Authors: F Llopis-Roca; R López Izquierdo; O Miro; J E García-Lamberechts; A Julián Jiménez; J González Del Castillo Journal: Rev Esp Quimioter Date: 2022-02-01 Impact factor: 1.553