University of Kansas School of Medicine, Kansas City, KS.
Department of Biostatistics, University of Kansas, Kansas City, KS.
Chest. 2018 Jan;153(1):39-45. doi: 10.1016/j.chest.2017.09.031. Epub 2017 Oct 5.
The aim of this study was to compare completion of the Surviving Sepsis Campaign 3-hour treatment recommendations and patient-centered outcomes between patients with severe sepsis who received a sepsis-specific diagnosis code with those who did not.
This was a retrospective cohort analysis of adult patients admitted through an academic medical center 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 diagnosed with severe sepsis and those who were not.
A total of 5,631 patients were identified (60.6 ± 17.2 years of age; 48.9% women). Less than half (32.8%) received an International Classification of Diseases, ninth revision, 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 < .005), as well as therapeutic components at a higher frequency (36.0% vs 29.0%; P < .001). Patients with a diagnosis code had higher mortality (6.3% vs 2.3%), more frequent ICU admissions (44.7% vs 22.5%), and longer hospitalizations (9.2 ± 6.9 days vs 6.9 ± 6.7 days) than did patients with severe sepsis with no diagnosis code (all P < .001).
Severe sepsis continues to be an underdiagnosed and undertreated condition. Patients who were diagnosed had 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.
本研究旨在比较接受脓毒症特定诊断代码的严重脓毒症患者与未接受诊断代码的患者在完成《拯救脓毒症运动 3 小时治疗建议》和以患者为中心的结局方面的差异。
这是一项回顾性队列分析，纳入了通过学术医疗中心急诊科就诊并接受抗生素治疗且符合严重脓毒症标准的成年患者。我们测量并比较了诊断为严重脓毒症的患者和未诊断为严重脓毒症的患者在完成《拯救脓毒症运动 3 小时治疗建议》以及以患者为中心的结局方面的差异。
共确定了 5631 例患者（60.6±17.2 岁；48.9%女性）。不到一半（32.8%）患者的国际疾病分类，第 9 版诊断代码为 995.92。所有患者在<3 小时内完成所有四个捆绑包组成部分的比例均较低（8.72%）。治疗性组成部分（广谱抗生素和静脉补液）的完成率较高（31.3%）。那些有诊断代码的患者接受了所有四个捆绑包组成部分（10.2%比 7.9%；P<0.005），以及更高频率的治疗性组成部分（36.0%比 29.0%；P<0.001）。有诊断代码的患者死亡率更高（6.3%比 2.3%），更频繁入住 ICU（44.7%比 22.5%），住院时间更长（9.2±6.9 天比 6.9±6.7 天），与无诊断代码的严重脓毒症患者相比（均 P<0.001）。
严重脓毒症仍然是一种诊断不足和治疗不足的疾病。接受诊断的患者治疗率更高，但结局更差。需要进一步研究以确定导致严重脓毒症患者诊断、治疗和结局的因素。
