320: Physiologic parameters and sepsis bundle failures during the 2017-2018 influenza season

Abstract

We characterized gravidas with influenza-like illness during the 2017-2018 influenza season in the context of a hospital-wide sepsis bundle. The bundle is triggered for any 2 abnormal vital signs, defined as: temperature < 36°C or ≥38°C, heart rate >90/min, systolic blood pressure < 90mmHg, and respiratory rate >20/min. This was a retrospective cohort study of 2017-2018 encounters for influenza-like illness (ILI), defined as respiratory symptoms for which a rapid flu test was ordered. Multiple encounters during a single pregnancy were possible. We excluded patients with RSV, pyelonephritis, non-influenza indications, or indeterminate flu testing. We compared “abnormal” vital signs recorded within 4h of presentation and hospitalization rates among gravidas with positive versus negative flu tests. Missing values were assumed normal. Between September 1, 2017 and March 31, 2018, 913 encounters for ILI were identified. Of these, 100(11%) were excluded (Figure 1). Of the 165 first, 271 second, and 377 third trimester encounters, 64(39%), 85(31%), and 144(38%) were influenza-positive, respectively (Table 1). Influenza positivity was associated with “abnormal” vital signs in all trimesters. Influenza-positive gravidas had two to three times the risk of having 2 abnormal vital signs, which would trigger sepsis bundle initiation and assessment for end-organ damage (i.e., lactate). Relative to influenza-negative encounters, influenza-positivity was associated with 1.6 to 2.1 times the risk for hospital admission for all trimesters, though absolute frequency of admission was low: 36%, 44%, and 58% for each trimester. ICU admission was rare. Influenza-positivity in pregnancy is associated with vitals signs that trigger a sepsis alert requiring further action, regardless of trimester. Despite higher risk for hospital admission among gravidas with influenza, most women are actually discharged after evaluation. A hospital-wide sepsis bundle fails to identify pregnant women with influenza at highest risk for severe morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)