Can the characteristics of emergency department attendances predict poor hospital outcomes inpatients with sepsis?

Abstract

INTRODUCTION The emergency department (ED) is often the initial site of identification of patients with sepsis. We aimed to determine the characteristics of ED attendances that predict poor hospital outcomes.METHODS We conducted a retrospective cohort study of adult patients in eight metropolitan EDs from 2001 to 2006 in Perth, Western Australia. Patients diagnosed with sepsis in the ED were identified using the International Classification of Diseases-10-AM code in the Emergency Department Information System (EDIS) database. The EDIS database was subsequently linked to the mortality and hospital morbidity records. We examined the triage category, mode of arrival, source of referral and hospital of presentation. Multivariate logistic regression was performed to identify predictors of hospital mortality, prolonged length of stay and admissions to the intensive care unit (ICU).RESULTS In the 1,311 patients who were diagnosed with sepsis in the ED, the hospital mortality and ICU admission rates were 19.5% and 18.5%, respectively. The mean hospital length of stay was 12 ±15 days. Acute triage categories predicted both hospital mortality and ICU admissions, while mode of arrival by ambulance was a predictor of all poor hospital outcomes (p < 0.001). Patients who presented to non-teaching hospitals have similar hospital outcomes compared with patients who presented to teaching hospitals. The source of referrals was not a predictor of poor hospital outcomes (p > 0.001).CONCLUSION Characteristics unique to the ED, mode of arrival and triage score may predict poor hospital outcomes in sepsis patients.