Sepsis in Brazilian emergency departments: a prospective multicenter observational study
We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who remained there due to inadequate allocation. Allocation...
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| Veröffentlicht in: | Internal and emergency medicine 2023-03, Vol.18 (2), p.409-421 |
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| creator | Machado, Flávia R. Cavalcanti, Alexandre B. Braga, Maria A. Tallo, Fernando S. Bossa, Aline Souza, Juliana L. Ferreira, Josiane F. Pizzol, Felipe dal Monteiro, Mariana B. Angus, Derek C. Lisboa, Thiago Azevedo, Luciano C. P. |
| description | We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who remained there due to inadequate allocation. Allocation was considered adequate if the patient was transferred to the intensive care unit (ICU), ward, or remained in the ED without ICU admission requests. Prevalence was estimated using the total ED visit number. Prognostic factors were assessed with logistic regression. Of 33,902 ED visits in 74 institutions, 183 were acute admissions (prevalence: 5.4 sepsis per 1000 visits [95% confidence interval (CI): 4.6–6.2)], and 148 were already in the ED; totaling 331 patients. Hospital mortality was 32% (103/322, 95% CI 23.0–51.0). Age (odds ratio (OR) 1.22 [95% CI 1.10–1.37]), Sequential Organ Failure Assessment (SOFA) score (OR 1.41 [95% CI 1.28–1.57]), healthcare-associated infections (OR 2.59 [95% CI 1.24–5.50]) and low-resource institution admission (OR 2.65 [95% CI 1.07–6.90]) were associated with higher mortality. Accredited institutions (OR 0.42 [95% CI 0.21–0.86]) had lower mortality rates. Allocation within 24 h was adequate in only 52.8% of patients (public hospitals: 42.4% (81/190) vs. private institutions: 67.4% (89/132,
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| doi_str_mv | 10.1007/s11739-022-03179-3 |
| format | Article |
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p
< 0.001) with 39.2% (74/189) of public hospital patients remaining in the ED until discharge, of whom 55.4% (41/74) died. Sepsis exerts high burden and mortality in Brazilian EDs with frequent inadequate allocation. Modifiable factors, such as resources and quality of care, are associated with reduced mortality.</description><identifier>ISSN: 1828-0447</identifier><identifier>EISSN: 1970-9366</identifier><identifier>DOI: 10.1007/s11739-022-03179-3</identifier><identifier>PMID: 36729268</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Brazil - epidemiology ; Emergency medical care ; Emergency Service, Hospital ; Hospital Mortality ; Hospitalization ; Humans ; Im - Original ; Intensive Care Units ; Internal Medicine ; Medicine ; Medicine & Public Health ; Mortality ; Observational studies ; Patients ; Prospective Studies ; Retrospective Studies ; Sepsis ; Sepsis - complications</subject><ispartof>Internal and emergency medicine, 2023-03, Vol.18 (2), p.409-421</ispartof><rights>The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI) 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ff2e5873950bb5d1fe0d67de81abc3b826271bc979f25fccfad1d897375abdc33</citedby><cites>FETCH-LOGICAL-c375t-ff2e5873950bb5d1fe0d67de81abc3b826271bc979f25fccfad1d897375abdc33</cites><orcidid>0000-0002-2356-4867</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11739-022-03179-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11739-022-03179-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27933,27934,41497,42566,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36729268$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Machado, Flávia R.</creatorcontrib><creatorcontrib>Cavalcanti, Alexandre B.</creatorcontrib><creatorcontrib>Braga, Maria A.</creatorcontrib><creatorcontrib>Tallo, Fernando S.</creatorcontrib><creatorcontrib>Bossa, Aline</creatorcontrib><creatorcontrib>Souza, Juliana L.</creatorcontrib><creatorcontrib>Ferreira, Josiane F.</creatorcontrib><creatorcontrib>Pizzol, Felipe dal</creatorcontrib><creatorcontrib>Monteiro, Mariana B.</creatorcontrib><creatorcontrib>Angus, Derek C.</creatorcontrib><creatorcontrib>Lisboa, Thiago</creatorcontrib><creatorcontrib>Azevedo, Luciano C. P.</creatorcontrib><creatorcontrib>SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</creatorcontrib><creatorcontrib>The SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</creatorcontrib><title>Sepsis in Brazilian emergency departments: a prospective multicenter observational study</title><title>Internal and emergency medicine</title><addtitle>Intern Emerg Med</addtitle><addtitle>Intern Emerg Med</addtitle><description>We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who remained there due to inadequate allocation. Allocation was considered adequate if the patient was transferred to the intensive care unit (ICU), ward, or remained in the ED without ICU admission requests. Prevalence was estimated using the total ED visit number. Prognostic factors were assessed with logistic regression. Of 33,902 ED visits in 74 institutions, 183 were acute admissions (prevalence: 5.4 sepsis per 1000 visits [95% confidence interval (CI): 4.6–6.2)], and 148 were already in the ED; totaling 331 patients. Hospital mortality was 32% (103/322, 95% CI 23.0–51.0). Age (odds ratio (OR) 1.22 [95% CI 1.10–1.37]), Sequential Organ Failure Assessment (SOFA) score (OR 1.41 [95% CI 1.28–1.57]), healthcare-associated infections (OR 2.59 [95% CI 1.24–5.50]) and low-resource institution admission (OR 2.65 [95% CI 1.07–6.90]) were associated with higher mortality. Accredited institutions (OR 0.42 [95% CI 0.21–0.86]) had lower mortality rates. Allocation within 24 h was adequate in only 52.8% of patients (public hospitals: 42.4% (81/190) vs. private institutions: 67.4% (89/132,
p
< 0.001) with 39.2% (74/189) of public hospital patients remaining in the ED until discharge, of whom 55.4% (41/74) died. Sepsis exerts high burden and mortality in Brazilian EDs with frequent inadequate allocation. Modifiable factors, such as resources and quality of care, are associated with reduced mortality.</description><subject>Adult</subject><subject>Brazil - epidemiology</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Hospital Mortality</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Im - Original</subject><subject>Intensive Care Units</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Sepsis</subject><subject>Sepsis - complications</subject><issn>1828-0447</issn><issn>1970-9366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kElrHDEQhUWI8Xj7AzkEQS65tK1lukvKLR68wYAPTsA3oZaqjUxvkboHJr_eGo-TQA4-VUF99erVI-QTZ-ecMbhInIPUBROiYJKDLuQHcsQ1sELLqvqYeyVUwZZLWJDjlJ4ZK8uKwyFZyAqEFpU6Io8POKaQaOjpZbS_QxtsT7HD-IS921KPo41Th_2UvlFLxzikEd0UNki7uZ2CyxOMdKgTxo2dwtDblqZp9ttTctDYNuHZWz0hP6-vfqxui_X9zd3q-7pwEsqpaBqBpcpvlKyuS88bZL4Cj4rb2slaiUoAr50G3Yiyca6xnnulIS_b2jspT8jXvW729mvGNJkuJIdta3sc5mQEANdLKbnO6Jf_0OdhjtnxjlLAAJZqR4k95fKzKWJjxhg6G7eGM7PL3exzNzl385q72bn4_CY91x36vyt_gs6A3AMpj_onjP9uvyP7AhB5j5c</recordid><startdate>20230301</startdate><enddate>20230301</enddate><creator>Machado, Flávia R.</creator><creator>Cavalcanti, Alexandre B.</creator><creator>Braga, Maria A.</creator><creator>Tallo, Fernando S.</creator><creator>Bossa, Aline</creator><creator>Souza, Juliana L.</creator><creator>Ferreira, Josiane F.</creator><creator>Pizzol, Felipe dal</creator><creator>Monteiro, Mariana B.</creator><creator>Angus, Derek C.</creator><creator>Lisboa, Thiago</creator><creator>Azevedo, Luciano C. P.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2356-4867</orcidid></search><sort><creationdate>20230301</creationdate><title>Sepsis in Brazilian emergency departments: a prospective multicenter observational study</title><author>Machado, Flávia R. ; Cavalcanti, Alexandre B. ; Braga, Maria A. ; Tallo, Fernando S. ; Bossa, Aline ; Souza, Juliana L. ; Ferreira, Josiane F. ; Pizzol, Felipe dal ; Monteiro, Mariana B. ; Angus, Derek C. ; Lisboa, Thiago ; Azevedo, Luciano C. 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P.</creatorcontrib><creatorcontrib>SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</creatorcontrib><creatorcontrib>The SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Internal and emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Machado, Flávia R.</au><au>Cavalcanti, Alexandre B.</au><au>Braga, Maria A.</au><au>Tallo, Fernando S.</au><au>Bossa, Aline</au><au>Souza, Juliana L.</au><au>Ferreira, Josiane F.</au><au>Pizzol, Felipe dal</au><au>Monteiro, Mariana B.</au><au>Angus, Derek C.</au><au>Lisboa, Thiago</au><au>Azevedo, Luciano C. P.</au><aucorp>SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</aucorp><aucorp>The SPREAD ED Investigators, the Instituto Latino Americano de Sepsis Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sepsis in Brazilian emergency departments: a prospective multicenter observational study</atitle><jtitle>Internal and emergency medicine</jtitle><stitle>Intern Emerg Med</stitle><addtitle>Intern Emerg Med</addtitle><date>2023-03-01</date><risdate>2023</risdate><volume>18</volume><issue>2</issue><spage>409</spage><epage>421</epage><pages>409-421</pages><issn>1828-0447</issn><eissn>1970-9366</eissn><abstract>We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who remained there due to inadequate allocation. Allocation was considered adequate if the patient was transferred to the intensive care unit (ICU), ward, or remained in the ED without ICU admission requests. Prevalence was estimated using the total ED visit number. Prognostic factors were assessed with logistic regression. Of 33,902 ED visits in 74 institutions, 183 were acute admissions (prevalence: 5.4 sepsis per 1000 visits [95% confidence interval (CI): 4.6–6.2)], and 148 were already in the ED; totaling 331 patients. Hospital mortality was 32% (103/322, 95% CI 23.0–51.0). Age (odds ratio (OR) 1.22 [95% CI 1.10–1.37]), Sequential Organ Failure Assessment (SOFA) score (OR 1.41 [95% CI 1.28–1.57]), healthcare-associated infections (OR 2.59 [95% CI 1.24–5.50]) and low-resource institution admission (OR 2.65 [95% CI 1.07–6.90]) were associated with higher mortality. Accredited institutions (OR 0.42 [95% CI 0.21–0.86]) had lower mortality rates. Allocation within 24 h was adequate in only 52.8% of patients (public hospitals: 42.4% (81/190) vs. private institutions: 67.4% (89/132,
p
< 0.001) with 39.2% (74/189) of public hospital patients remaining in the ED until discharge, of whom 55.4% (41/74) died. Sepsis exerts high burden and mortality in Brazilian EDs with frequent inadequate allocation. Modifiable factors, such as resources and quality of care, are associated with reduced mortality.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36729268</pmid><doi>10.1007/s11739-022-03179-3</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-2356-4867</orcidid></addata></record> |
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| subjects | Adult Brazil - epidemiology Emergency medical care Emergency Service, Hospital Hospital Mortality Hospitalization Humans Im - Original Intensive Care Units Internal Medicine Medicine Medicine & Public Health Mortality Observational studies Patients Prospective Studies Retrospective Studies Sepsis Sepsis - complications |
| title | Sepsis in Brazilian emergency departments: a prospective multicenter observational study |
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