Recognition and treatment of severe sepsis in the emergency department: retrospective study in two French teaching hospitals

BMC Emergency Medicine

Research Article

Emmanuel Montassier¹  Séverin Thibergien¹  Gilles Potel¹  Eric Batard¹  Philippe Le Conte¹  Pierre Marie Roy²  Jean Batiste Obellianne² 

[1] Service des urgences, CHU de Nantes, 44035, Nantes cedex 01, France;Service des urgences, CHU d’Angers, 49000, Angers cedex, France;

关键词: Severe sepsis;    Emergency medicine;    Surviving sepsis campaign;    Bundles;    Fluid loading;    Recognition;   

DOI  :  10.1186/s12873-017-0133-6

 received in 2017-02-06, accepted in 2017-06-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSepsis management in the Emergency Department remains a daily challenge. The Surviving Sepsis Campaign (SSC) has released three-hour bundle. The implementation of these bundles in European Emergency Departments remains poorly described.The main objective was to assess the compliance with the Severe Sepsis Campaign 3-h bundle (blood culture, lactate dosage, first dose of antibiotics and 30 ml/kg fluid challenge). Secondary objectives were the analysis of the delay of severe sepsis recognition and description of the population.MethodsIn accordance with STROBE statement, we performed a retrospective study in two French University Hospital Emergency Departments from February to August 2015. Patients admitted during the study period were screened using the electronic files of the hospital databases. Patient’s files were reviewed and included in the study if they met severe sepsis criteria. Demographics, comorbities, treatments were recorded. Delays from admission to severe sepsis diagnosis, fluid loading onset and antibiotics administration were calculated.ResultsOne hundred thirty patients were included (76 men, mean age 71 ± 14 years). Blood culture, lactate dosage, antibiotics and 30 ml/kg fluid loading were performed within 3 hours in % [95% confidence interval] 100% [96–100%], 62% [54–70%], 49% [41–58%] and 19% [13–27%], respectively. 25 patients out of 130 (19% [13–27%]) fulfilled each criteria of the 3-h bundle. The mean fluid loading volume was 18 ± 11 ml/kg. Mean delay between presentation and severe sepsis diagnosis was 200 ± 263 min, from diagnosis to fluid challenge and first antibiotic dose, 10 ± 27 min and 20 ± 55 min, respectively.ConclusionCompliance with SSC 3-h bundle and delay between admission and sepsis recognition have to be improved. If confirmed by other studies, an improvement program might be deployed.

【 授权许可】

CC BY   
© The Author(s). 2017