Kaldjian Anna M, Vakkalanka Priyanka, Okoro Uche, Wymore Cole, Harland Karisa K, Campbell Kalyn, Swanson Morgan B, Fuller Brian M, Faine Brett, Zepeski Anne, Parker Edith A, Mack Luke, Bell Amanda, DeJong Katie, Wallace Kelli, Mueller Keith, Chrischilles Elizabeth, Carpenter Christopher R, Jones Michael P, Ward Marcia M, Mohr Nicholas M
University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
Department of Surgery, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA.
Telemed J E Health. 2025 Jul;31(7):848-857. doi: 10.1089/tmj.2024.0281. Epub 2025 Mar 19.
Provider-to-provider emergency department telehealth (tele-ED) has been proposed to improve rural sepsis care. The objective of this study was to measure the association between sepsis documentation and tele-ED use, treatment guideline adherence, and mortality. This analysis was a multicenter ( = 23) cohort study of sepsis patients treated in rural emergency departments (EDs) that participated in a tele-ED network between August 2016 and June 2019. The primary outcome was whether sepsis was documented explicitly in the clinical note impression in the local ED, and the primary exposure was rural tele-ED use, with secondary outcomes of time to tele-ED use, 3-h guideline adherence, and in-hospital mortality. Data from 1,146 rural sepsis patients were included, 315 (27%) had tele-ED used and 415 (36%) had sepsis recognized in the rural ED. Tele-ED use was not independently associated with sepsis recognition (adjusted odds ratio [aOR]: 1.23, 95% confidence interval [CI]: 0.90-1.67). Sepsis recognition was associated with earlier tele-ED activation (adjusted hazard ratio 1.66, 95% CI: 1.28-2.15) and greater 3-h guideline adherence (aOR 1.37, 95% CI 1.03-1.83) Sepsis recognition was not independently associated with mortality (aOR 1.32, 95% CI 0.97-1.80). Although tele-ED care is a promising strategy to improve sepsis outcomes, its use was limited by under-recognition of sepsis in rural EDs.
有人提议采用医疗机构之间的急诊科远程医疗（远程急诊）来改善农村地区的脓毒症护理。本研究的目的是衡量脓毒症记录与远程急诊使用、治疗指南遵循情况和死亡率之间的关联。该分析是一项多中心（n = 23）队列研究，研究对象为2016年8月至2019年6月期间在参与远程急诊网络的农村急诊科接受治疗的脓毒症患者。主要结局是当地急诊科的临床记录印象中是否明确记录了脓毒症，主要暴露因素是农村远程急诊的使用情况，次要结局包括开始使用远程急诊的时间、3小时内遵循指南的情况以及住院死亡率。纳入了1146例农村脓毒症患者的数据，其中315例（27%）使用了远程急诊，415例（36%）在农村急诊科被诊断为脓毒症。远程急诊的使用与脓毒症的诊断并无独立关联（调整后的优势比[aOR]：1.23，95%置信区间[CI]：0.90 - 1.67）。脓毒症的诊断与更早启动远程急诊相关（调整后的风险比为1.66，95% CI：1.28 - 2.15），且与3小时内更高的指南遵循率相关（aOR 1.37，95% CI 1.03 - 1.83）。脓毒症的诊断与死亡率并无独立关联（aOR 1.32，95% CI 0.97 - 1.80）。尽管远程急诊护理是改善脓毒症治疗效果的一项有前景的策略，但其应用受到农村急诊科对脓毒症认识不足的限制。
