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 observatio...
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| Veröffentlicht in: | The American journal of emergency medicine 2025-04, Vol.90, p.61-64 |
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| creator | Ameripour, Arman Herrera, Elizabeth Coskey, Olivia Ng, Justin Cornejo Ochoa, Cesar Modesette, Allison Lee, Jenny T. Chun, Truman Ray K.G.C. Kaur, Jasmeet Hertel, Andrew W. Smith, Barry C. Delmonaco, Brian L. |
| description | 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 |
| doi_str_mv | 10.1016/j.ajem.2025.01.018 |
| format | Article |
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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 < 0.001), and a moderately abnormal lactate (OR: 0.32, 95 % CI: 0.12–0.79, p = 0.02).
Early identification of sepsis, as well as attention to prior ICU admission or comorbidities and abnormal red cell distribution width, could facilitate better care and prevent mortality among patients with sepsis who are transferred from a rural, low-volume emergency department to an urban-high volume facility.</description><identifier>ISSN: 0735-6757</identifier><identifier>ISSN: 1532-8171</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2025.01.018</identifier><identifier>PMID: 39818036</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Intensive care unit ; Lactate level ; Red cell distribution ; Regionalization ; Rural ; Sepsis ; Transfer</subject><ispartof>The American journal of emergency medicine, 2025-04, Vol.90, p.61-64</ispartof><rights>2025 Elsevier Inc.</rights><rights>Copyright © 2025 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c237t-6111c8e3a3c9e153ffd14e65ed586f39cab1dc03101924b4836bbdc71fda470e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735675725000191$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39818036$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ameripour, Arman</creatorcontrib><creatorcontrib>Herrera, Elizabeth</creatorcontrib><creatorcontrib>Coskey, Olivia</creatorcontrib><creatorcontrib>Ng, Justin</creatorcontrib><creatorcontrib>Cornejo Ochoa, Cesar</creatorcontrib><creatorcontrib>Modesette, Allison</creatorcontrib><creatorcontrib>Lee, Jenny T.</creatorcontrib><creatorcontrib>Chun, Truman Ray K.G.C.</creatorcontrib><creatorcontrib>Kaur, Jasmeet</creatorcontrib><creatorcontrib>Hertel, Andrew W.</creatorcontrib><creatorcontrib>Smith, Barry C.</creatorcontrib><creatorcontrib>Delmonaco, Brian L.</creatorcontrib><title>Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>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 < 0.001), and a moderately abnormal lactate (OR: 0.32, 95 % CI: 0.12–0.79, p = 0.02).
Early identification of sepsis, as well as attention to prior ICU admission or comorbidities and abnormal red cell distribution width, could facilitate better care and prevent mortality among patients with sepsis who are transferred from a rural, low-volume emergency department to an urban-high volume facility.</description><subject>Intensive care unit</subject><subject>Lactate level</subject><subject>Red cell distribution</subject><subject>Regionalization</subject><subject>Rural</subject><subject>Sepsis</subject><subject>Transfer</subject><issn>0735-6757</issn><issn>1532-8171</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><recordid>eNp9kM1r3DAQxUVoyW4-_oEeio49xFuNZfkDcinJJi0EkkN7FrI8ymqxLUeSs-S_j5bd9BgYmMO894b3I-QbsBUwKH9uV2qLwypnuVgxSFOfkCUInmc1VPCFLFnFRVZWolqQsxC2jAEUojglC97UUDNeLsnuyWNndXQ-UGfo4HxUvY1vVA1ufKYBp2ADnVS0OMZAo1djMOiTiRrvBqqon73qr2jvdtmr6-cB6fqWRkfVSGffqvGKbuzz5uO2cWGy6cUF-WpUH_DyuM_Jv7v135vf2cPj_Z-bXw-ZznkVsxIAdI1ccd1gqmZMBwWWAjtRl4Y3WrXQacYTjyYv2qLmZdt2ugLTqaJiyM_Jj0Pu5N3LjCHKwQaNfa9GdHOQHEQp8qYpeJLmB6n2LgSPRk7eDsq_SWByD1xu5R643AOXDNLUyfT9mD-3A3b_LR-Ek-D6IMDU8tWil0EnljpR96ij7Jz9LP8djfmTXw</recordid><startdate>20250401</startdate><enddate>20250401</enddate><creator>Ameripour, Arman</creator><creator>Herrera, Elizabeth</creator><creator>Coskey, Olivia</creator><creator>Ng, Justin</creator><creator>Cornejo Ochoa, Cesar</creator><creator>Modesette, Allison</creator><creator>Lee, Jenny T.</creator><creator>Chun, Truman Ray K.G.C.</creator><creator>Kaur, Jasmeet</creator><creator>Hertel, Andrew W.</creator><creator>Smith, Barry C.</creator><creator>Delmonaco, Brian L.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20250401</creationdate><title>Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital</title><author>Ameripour, Arman ; Herrera, Elizabeth ; Coskey, Olivia ; Ng, Justin ; Cornejo Ochoa, Cesar ; Modesette, Allison ; Lee, Jenny T. ; Chun, Truman Ray K.G.C. ; Kaur, Jasmeet ; Hertel, Andrew W. ; Smith, Barry C. ; Delmonaco, Brian L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c237t-6111c8e3a3c9e153ffd14e65ed586f39cab1dc03101924b4836bbdc71fda470e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Intensive care unit</topic><topic>Lactate level</topic><topic>Red cell distribution</topic><topic>Regionalization</topic><topic>Rural</topic><topic>Sepsis</topic><topic>Transfer</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ameripour, Arman</creatorcontrib><creatorcontrib>Herrera, Elizabeth</creatorcontrib><creatorcontrib>Coskey, Olivia</creatorcontrib><creatorcontrib>Ng, Justin</creatorcontrib><creatorcontrib>Cornejo Ochoa, Cesar</creatorcontrib><creatorcontrib>Modesette, Allison</creatorcontrib><creatorcontrib>Lee, Jenny T.</creatorcontrib><creatorcontrib>Chun, Truman Ray K.G.C.</creatorcontrib><creatorcontrib>Kaur, Jasmeet</creatorcontrib><creatorcontrib>Hertel, Andrew W.</creatorcontrib><creatorcontrib>Smith, Barry C.</creatorcontrib><creatorcontrib>Delmonaco, Brian L.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ameripour, Arman</au><au>Herrera, Elizabeth</au><au>Coskey, Olivia</au><au>Ng, Justin</au><au>Cornejo Ochoa, Cesar</au><au>Modesette, Allison</au><au>Lee, Jenny T.</au><au>Chun, Truman Ray K.G.C.</au><au>Kaur, Jasmeet</au><au>Hertel, Andrew W.</au><au>Smith, Barry C.</au><au>Delmonaco, Brian L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital</atitle><jtitle>The American journal of emergency medicine</jtitle><addtitle>Am J Emerg Med</addtitle><date>2025-04-01</date><risdate>2025</risdate><volume>90</volume><spage>61</spage><epage>64</epage><pages>61-64</pages><issn>0735-6757</issn><issn>1532-8171</issn><eissn>1532-8171</eissn><abstract>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 < 0.001), and a moderately abnormal lactate (OR: 0.32, 95 % CI: 0.12–0.79, p = 0.02).
Early identification of sepsis, as well as attention to prior ICU admission or comorbidities and abnormal red cell distribution width, could facilitate better care and prevent mortality among patients with sepsis who are transferred from a rural, low-volume emergency department to an urban-high volume facility.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>39818036</pmid><doi>10.1016/j.ajem.2025.01.018</doi><tpages>4</tpages></addata></record> |
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| subjects | Intensive care unit Lactate level Red cell distribution Regionalization Rural Sepsis Transfer |
| title | Predictors of mortality among sepsis patients transferred from a rural, low-volume ED to an urban, high-volume hospital |
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