Failla Kim Reina, Connelly Cynthia D, Ecoff Laurie, Macauley Karen, Bush Ruth
Gamma Gamma and Zeta Mu, Manager, Nurse Residency Program, Sharp Memorial Hospital, San Diego, CA, USA.
Zeta Mu, Professor and Director of Nursing Research, Beyster Institute of Nursing Research, University of San Diego, San Diego, CA, USA.
J Nurs Scholarsh. 2019 Jul;51(4):438-448. doi: 10.1111/jnu.12478. Epub 2019 Apr 2.
The purpose of this study was to examine potential gender disparities in relation to factors associated with sepsis management among a cohort of patients admitted through an emergency department with a discharge diagnosis of severe sepsis or septic shock. Sepsis is one of the leading causes of death globally, with significant associated costs. Predictors of survival for those with sepsis-related diagnoses are complex.
The study had a retrospective, descriptive cross-sectional design. The sample (N = 482) included patients 18 years of age or older who presented to the emergency department of a nonprofit, Magnet-recognized, acute care hospital located in southern California. Subjects included those who subsequently met the criteria for a discharge diagnosis of severe sepsis or septic shock as defined by the Surviving Sepsis Campaign. Patient characteristics, clinical variables, care management processes, and outcomes were extracted from the electronic health record. A multivariate model was analyzed.
The sample included 234 women (48.5%) and 248 men (51.5%). Logistic regression with eight independent variables (discharge diagnosis, age, comorbidities, length of hospital stay, source of infection, first serum lactate level measured, recommended fluids administered, and gender) reliably predicted odds for patient survival, ϰ (12) = 118.38, p < .001, and correctly classified 77.3% of cases. All eight independent variables significantly contributed to the model. Men had a higher likelihood of hospital survival than women (odds ratio 1.68; 95% confidence interval 1.01-2.79; p = .045).
The Surviving Sepsis Campaign has provided a clear pathway for care of patients with sepsis-related diagnoses. Therapeutic strategies should be developed to address differences in outcome by gender. The adoption of more aggressive applications of evidence-based interventions for these patients may result in better patient outcomes.
Providers should understand the importance of adhering to sepsis protocols, minimizing treatment disparities, and recognizing gender differences.
本研究旨在调查因严重脓毒症或脓毒性休克出院诊断而通过急诊科入院的一组患者中，与脓毒症管理相关因素的潜在性别差异。脓毒症是全球主要死因之一，伴有高昂的相关费用。脓毒症相关诊断患者的生存预测因素很复杂。
本研究采用回顾性描述性横断面设计。样本（N = 482）包括18岁及以上到位于南加州的一家非营利性、获磁体认证的急症护理医院急诊科就诊的患者。研究对象包括那些随后符合脓毒症存活行动定义的严重脓毒症或脓毒性休克出院诊断标准的患者。从电子健康记录中提取患者特征、临床变量、护理管理流程和结果。分析了一个多变量模型。
样本包括234名女性（48.5%）和248名男性（51.5%）。对八个自变量（出院诊断、年龄、合并症、住院时间、感染源、首次测得的血清乳酸水平、推荐给予的液体量和性别）进行逻辑回归，可靠地预测了患者生存几率，卡方（12）= 118.38，p <.001，正确分类了77.3%的病例。所有八个自变量对模型均有显著贡献。男性的医院生存可能性高于女性（优势比1.68；95%置信区间1.01 - 2.79；p = 0.045）。
脓毒症存活行动为脓毒症相关诊断患者的护理提供了明确途径。应制定治疗策略以解决性别在治疗结果上的差异。对这些患者采用更积极的循证干预措施可能会带来更好的患者治疗结果。
医疗服务提供者应理解遵守脓毒症治疗方案、尽量减少治疗差异以及认识性别差异的重要性。
