Wang Zhen, Xiong Yingxia, Schorr Christa, Dellinger R P
Department of Emergency Medicine, Beijing Shi-Ji-Tan Hospital, Beijing, China.
J Emerg Med. 2013 Apr;44(4):735-41. doi: 10.1016/j.jemermed.2012.07.084. Epub 2013 Jan 16.
It is well known that poor sepsis outcomes are related to delays in diagnosis and treatment.
The aim of this study was to compare the mortality rate between two groups of patients, one group presenting before and one group presenting after implementation of the Surviving Sepsis Campaign (SSC) sepsis performance improvement bundles in the Emergency Department (ED).
This was a prospective study. The studied population included severe sepsis and septic shock patients entered in the SSC database who were admitted to the ED between June 2008 and December 2009. Patients were divided into two groups based on when they presented to the ED. Key treatment interventions, admission to the intensive care unit, and in-hospital mortality were compared. In addition, a survey was completed by the treating physicians to identify reasons for failures to comply with indicators.
One hundred ninety-five (195) patients with severe sepsis and septic shock were enrolled in the study. Mortality was significantly higher at 44.8% in the baseline group (Group 1) compared to 31.6% in the group studied after the SSC protocol was instituted (Group 2) (p < 0.05). Compliance with all elements of the sepsis resuscitation bundle was 1% in Group 1 and 9% in Group 2 (p < 0.05). Compliance with all elements of the management bundle was 1% in Group 1 and 12.8% in Group 2. The most frequently reported reasons by physicians for failure to comply with the bundles were: "did not think it was needed" and "unsure of reason."
The results revealed a significant drop in mortality after implementing the SSC protocol and sepsis performance improvement bundles in the ED. The barriers to implementing sepsis guidelines are knowledge, attitude, and behavioral barriers.
众所周知，脓毒症治疗效果不佳与诊断和治疗延误有关。
本研究旨在比较两组患者的死亡率，一组是在急诊科实施“拯救脓毒症运动”（SSC）脓毒症绩效改进集束化治疗之前就诊的患者，另一组是在实施之后就诊的患者。
这是一项前瞻性研究。研究人群包括2008年6月至2009年12月期间入住急诊科并录入SSC数据库的严重脓毒症和脓毒性休克患者。根据患者到急诊科就诊的时间将其分为两组。比较关键治疗干预措施、入住重症监护病房情况和院内死亡率。此外，治疗医师完成了一项调查，以确定未遵守指标的原因。
195例严重脓毒症和脓毒性休克患者纳入本研究。基线组（第1组）的死亡率显著更高，为44.8%，而在实施SSC方案后研究的组（第2组）中为31.6%（p<0.05）。第1组对脓毒症复苏集束化治疗所有要素的依从率为1%，第2组为9%（p<0.05）。第1组对管理集束化治疗所有要素的依从率为1%，第2组为12.8%。医师报告的最常见未遵守集束化治疗的原因是：“认为不需要”和“原因不明”。
结果显示，在急诊科实施SSC方案和脓毒症绩效改进集束化治疗后死亡率显著下降。实施脓毒症指南的障碍是知识、态度和行为方面的障碍。
