Clinical and Demographic Parameters of Patients Treated Using a Sepsis Protocol

Authors

Hillary H. Ward DO, Lehigh Valley Health NetworkFollow
Emily A. Kiernan DO, Lehigh Valley Health NetworkFollow
Chris Deschler BSN, RN, CPHQ, Lehigh Valley Health NetworkFollow
Sofia M. Murillo BS, Lehigh Valley Health Network
Elizabeth Karoly MBA, Lehigh Valley Health NetworkFollow
Jennifer E. Macfarlan MPH, Lehigh Valley Health NetworkFollow
Matthew McCambridge MD, Lehigh Valley Health NetworkFollow
David M. Richardson MD, Lehigh Valley Health NetworkFollow
Richard S. MacKenzie MD, Lehigh Valley Health NetworkFollow
Marna R. Greenberg DO, MPH, FACEP, Lehigh Valley Health NetworkFollow
Jeanne L. Jacoby MD, Lehigh Valley Health NetworkFollow

Publication/Presentation Date

6-2019

Abstract

Purpose

The purpose of this study was to investigate potential differences by sex in the demographic and clinical characteristics of patients treated utilizing a sepsis electronic bundle order set. Risk factors for in-hospital mortality were also assessed.

Methods

Data on patients in whom the sepsis order set was initiated in the emergency department over a 16-month period were entered into the hospital database. Data were analyzed for differences by sex in demographic and clinical factors, treatment modalities, and in-hospital mortality. The Bonferroni correction was applied to account for multiple comparisons; α was set at 0.006 for sex differences.

Findings

A total of 2204 patients were included. Male and female cohorts were similar with regard to a variety of demographic and clinical factors, including age, Emergency Severity Index (ESI) levels 1 and 2, time to disposition, appropriateness of antibiotics, and total fluids given by weight. The ESI is an assessment score ranging from 1 to 5 (1 is emergent). There were modest differences in the source of infection (genitourinary was 4% more common in women; P = 0.03) and mode of arrival (men were 4% more likely to arrive by ambulance; P = 0.03). These differences did not achieve our predefined α of 0.006 when the Bonferroni correction was applied. Factors associated with in-hospital mortality were advanced age, arrival by ambulance, and an ESI level of 1 or 2 (all, P < 0.01).

Implications

Women were more likely to have a genitourinary cause of sepsis and less likely to arrive by ambulance. Risk factors of in-hospital mortality were older age, arrival by ambulance, and an ESI level of 1 or 2, but not sex.

Volume

41

Issue

6

First Page

1020

Last Page

1028

Published In/Presented At

Ward, H. H., Kiernan, E. A., Deschler, C. Murillo, S. M., Karoly, S. Macfarlan, J. E., McCambridge, M. M., Richardson, D. M., MacKenzie, R. S., Greenberg, R. M., Jacoby, J. L. (2019, May). Clinical and Demographic Parameters of Patients Treated Using a Sepsis Protocol. Clinical Therapeutics, 41(6), 1020-1028. https://doi.org/10.1016/j.clinthera.2019.03.016

Disciplines

Emergency Medicine | Internal Medicine

PubMedID

31084993

Department(s)

Department of Emergency Medicine, Department of Emergency Medicine Faculty, Department of Emergency Medicine Residents, Network Office of Research and Innovation

Document Type

Article