Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital

We investigated the extent to which demographic characteristics, clinical care aspects, and relevant biomarkers predicted sepsis-related mortality among patients transferred from a rural, low-volume emergency department (ED) to an urban, high-volume, level-2 trauma center. We conducted an observational study among adult severe sepsis patients (N = 242) who, within a community-based regional healthcare system, presented to one of the four rural, low-volume EDs and were subsequently transferred to the urban, high-volume, level-2 trauma center, and were identified as septic at either location. We evaluated in-hospital and 30 days after discharge mortality. In-hospital mortality rate was predicted by previous admission to an ICU (OR 5.02, 95 % CI: 1.89–15.94, p = 0.002), identification of sepsis prior to transfer (OR 0.29, 95 % CI: 0.11–0.74, p = 0.01), and a moderately abnormal lactate level (OR 0.22, 95 % CI: 0.05–0.79, p = 0.03). Mortality 30 days after discharge was predicted by previous admission to an ICU (OR: 3.28, 95 % CI: 1.62–6.97, p = 0.001), abnormal red cell distribution width (OR: 2.23, 95 % CI: 1.11–4.60, p = 0.03), identification of sepsis prior to transfer (OR: 0.26, 95 % CI: 0.12–0.54, p