Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, Louisville, Kentucky.
Am J Med Sci. 2018 Jun;355(6):524-529. doi: 10.1016/j.amjms.2018.02.007. Epub 2018 Feb 21.
We evaluated the effect of time spent in the emergency department (ED) and process of care on mortality and length of hospital stay in patients with sepsis or septic shock.
An observational cohort study was conducted on 117 patients who came through the University of Louisville Hospital ED and subsequently were directly admitted to the intensive care unit (ICU). Variables of interest were time in the ED from triage to physical transport to the ICU, from triage to antibiotic(s) ordered, and from triage to antibiotic(s) administered. Expected mortality was calculated according to the University Health System Consortium Database. Primary and secondary outcomes were in-hospital death and hospital length of stay in days, respectively.
We found no significant association between time in the ED and mortality between survivors and nonsurvivors (5.5 versus 5.7 hours, P = 0.804). After adjusting for expected mortality, a 22% increase in mortality risk was found for each hour delay from triage to antibiotic(s) ordered; a 15% increase in mortality risk was observed for each hour from triage to antibiotic(s) given. Both time from triage to antibiotic(s) ordered (hazard ratio [HR] = 0.8, P = 0.044) and time from triage to antibiotic(s) delivery (HR = 0.79, P = 0.0092) were independently associated with an increased hospital stay (HR = 0.79, P = 0.0092).
Though no significant association between mortality and ED time was demonstrated, we observed a significant increase in mortality in septic patients with both delays in antibiotic(s) order and administration. Delay in care also resulted in increased hospital stays both overall and in the ICU.
我们评估了在急诊科（ED）停留时间和治疗过程对脓毒症或感染性休克患者死亡率和住院时间的影响。
对 117 名通过路易斯维尔大学医院急诊科并直接转入重症监护病房（ICU）的患者进行了一项观察性队列研究。感兴趣的变量包括从分诊到物理转运到 ICU 的 ED 时间、从分诊到开抗生素的时间以及从分诊到给予抗生素的时间。预期死亡率根据大学健康系统联盟数据库计算。主要和次要结局分别为住院期间死亡和住院天数。
我们发现存活者和非存活者在 ED 停留时间与死亡率之间没有显著关联（5.5 小时与 5.7 小时，P = 0.804）。在调整预期死亡率后，从分诊到开抗生素的时间每延迟 1 小时，死亡率风险增加 22%；从分诊到给予抗生素的时间每延迟 1 小时，死亡率风险增加 15%。从分诊到开抗生素的时间（危险比 [HR] = 0.8，P = 0.044）和从分诊到给予抗生素的时间（HR = 0.79，P = 0.0092）都与住院时间延长独立相关（HR = 0.79，P = 0.0092）。
尽管没有显示死亡率与 ED 时间之间存在显著关联，但我们观察到抗生素（s）的开方和给药延迟均导致脓毒症患者的死亡率显著增加。治疗的延迟也导致总住院时间和 ICU 住院时间延长。
