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Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis
Journal article   Open access   Peer reviewed

Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis

Seth W. Glickman, Charles B. Cairns, Ronny M. Otero, Christopher W. Woods, Ephraim L. Tsalik, Raymond J. Langley, Jennifer C. van Velkinburgh, Lawrence P. Park, Lawrence T. Glickman, Vance G. Fowler, …
Academic emergency medicine, v 17(4), pp 383-390
Apr 2010
DOI: https://doi.org/10.1111/j.1553-2712.2010.00664.x
PMID: 20370777
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1111/j.1553-2712.2010.00664.xView
Published, Version of Record (VoR) Open

Abstract

Emergency Medicine Life Sciences & Biomedicine Science & Technology
Background: Aggressive diagnosis and treatment of patients presenting to the emergency departments (ED) with septic shock has been shown to reduce mortality. To enhance the ability to intervene in patients with lesser illness severity, a better understanding of the natural history of the early progression from simple infection to more severe illness is needed. Objectives: The objectives were to 1) describe the clinical presentation of ED sepsis, including types of infection and causative microorganisms, and 2) determine thc incidence, patient characteristics, and mortality associated with early progression to septic shock among ED patients with infection. Methods. This was a multicenter study of adult ED patients with sepsis but no evidence of shock. Multivariable logistic regression was used to identify patient factors for early progression to shock and its association with 30-day mortality. Results: Of 472 patients not in shock at ED presentation (systolic blood pressure > 90 mm Hg and lactate < 4 mmol/L) 84 (178 degrees) progressed to shock thin 72 hours. Independent factors associated with early progression to shock included older age, female sex, hyperthermia, anemia, comorbid lung disease, and vascular access device infection. Early progression to shock (vs. no progression) as associated with higher 30-day mortality (13.1% vs 3.1%, odds ratio [OR] = 4.72, 95% confidence interval [CI] = 2.01 to 11.1; p <= 0.001). Among 379 patients with uncomplicated sepsis (i.e., no evidence of shock or any end-organ dysfunction), 86 (22.7%) progressed to severe sepsis or shock within 72 hours of hospital admission. Conclusions: A significant portion of ED patients with less severe sepsis progress to severe sepsis or shock within 72 hours. Additional diagnostic approaches are needed to risk stratify and more effectively treat ED patients with sepsis. ACADEMIC EMERGENCY MEDICINE 2010; 17:383 390 (C) 2010 by the Society for Academic Emergency Medicine.

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116 citations in Web of Science
123 citations in Scopus

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Emergency Medicine
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