Sriram Ramgopal1, Christopher M Horvat2, Mark D Adler3. 1. Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. Electronic address: sramgopal@luriechildrens.org. 2. Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States of America. 3. Division of Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
Abstract
PURPOSE: To identify if triage hypothermia (<36.0 °C) among emergency department (ED) encounters with sepsis are independently associated with mortality. METHODS: We analyzed data from a multi-stage probability sample survey of visits to United States EDs between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. We used multivariable regression to determine an association between hypothermia and in-hospital mortality. RESULTS: Of 1.2 billion ED encounters (95% confidence interval [CI] 1.0-1.3 billion), 3.1 million (95% CI 2.7-3.5 million) met the explicit sepsis definition; 7.4% (95% CI 75.2-9.7%) had triage hypothermia. The adjusted odds ratio (aOR) for hypothermia for in-hospital mortality was 6.82 (95% CI 3.08-15.22). The severe sepsis definition identified 3.5 million (95% 3.1-4.0 million) encounters; 30.3% (95% CI 25.0-34.6%) had triage hypothermia. The aOR for hypothermia with mortality was 4.08 (95% CI 2.09-7.95). Depending on sepsis definition, 78.1-84.4% had other systemic inflammatory response syndrome vital sign abnormalities. CONCLUSION: Up to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10-20% of patients with hypothermic sepsis do not have other vital sign abnormalities.
PURPOSE: To identify if triage hypothermia (<36.0 °C) among emergency department (ED) encounters with sepsis are independently associated with mortality. METHODS: We analyzed data from a multi-stage probability sample survey of visits to United States EDs between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. We used multivariable regression to determine an association between hypothermia and in-hospital mortality. RESULTS: Of 1.2 billion ED encounters (95% confidence interval [CI] 1.0-1.3 billion), 3.1 million (95% CI 2.7-3.5 million) met the explicit sepsis definition; 7.4% (95% CI 75.2-9.7%) had triage hypothermia. The adjusted odds ratio (aOR) for hypothermia for in-hospital mortality was 6.82 (95% CI 3.08-15.22). The severe sepsis definition identified 3.5 million (95% 3.1-4.0 million) encounters; 30.3% (95% CI 25.0-34.6%) had triage hypothermia. The aOR for hypothermia with mortality was 4.08 (95% CI 2.09-7.95). Depending on sepsis definition, 78.1-84.4% had other systemic inflammatory response syndrome vital sign abnormalities. CONCLUSION: Up to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10-20% of patients with hypothermic sepsis do not have other vital sign abnormalities.
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