3-Hour Bundle Compliance and Outcomes in Undiagnosed Severe Sepsis Patients.
Chest. 2017 Oct 05;:
Authors: Deis AS, Whiles BB, Brown AR, Satterwhite CL, Simpson SQ
BACKGROUND: To compare completion of the Surviving Sepsis Campaign, 3-hour treatment recommendations and patient-centered outcomes between patients who received a sepsis specific diagnosis to those who did not.
METHODS: A retrospective cohort analysis of adult patients admitted through an academic medical center emergency department (ED), who received an antibiotic, and met criteria for severe sepsis. We measured and compared the Surviving Sepsis Campaign 3-hour treatment recommendations, along with patient-centered outcomes in patients who were and were not diagnosed with severe sepsis.
RESULTS: A total of 5631 patients were identified (age 60.6 ± 17.2 years [mean ± standard deviation], 48.9% female). Less than half (32.8%) received an ICD-9 diagnosis code of 995.92. Completion of all four bundle components in <3 hours was low for all patients (8.72%). Therapeutic components - a broad spectrum antibiotic and IV fluids - were completed more often (31.3%). Those with a diagnosis code received all four bundle components (10.2% vs 7.9%, p<0.005), as well as therapeutic components at a higher frequency (36.0% vs 29.0%, p<0.001). Patients with a diagnosis code had higher mortality (6.3% vs 2.3%), more frequent ICU admission (44.7% vs 22.5%), and longer hospitalizations (9.2 ± 6.9 days vs 6.9 ± 6.7 days), than severe sepsis patients with no diagnosis code (all p <0.001).
CONCLUSIONS: Severe sepsis continues to be an underdiagnosed and undertreated condition. Patients who were diagnosed received higher treatment rates, yet experienced worse outcomes. Continued investigation is needed to identify factors contributing to diagnosis, treatment, and outcomes in patients with severe sepsis.
PMID: 28987477 [PubMed - as supplied by publisher]