338 EMS Sepsis Patients Are Different From Walk-in Sepsis Patients

Abstract

Study Objectives: Sepsis is a leading cause of morbidity and mortality worldwide. This study is a retrospective review of quality improvement data gathered from a large teaching hospital since November 2009. The aim of this study was to compare outcomes between patients presenting by emergency medical services compared to those presenting directly to the emergency department (ED).Methods: We prospectively identified and reviewed all cases of severe sepsis admitted to the medical intensive care unit from the ED in the 2-year period between 11/1/09 and 10/1/11. Emergency medical services variables extracted were vital signs, blood glucose, presence of altered mental status and transport times. ED variables were initial ED vitals, blood glucose, presence of altered mental status and serum lactate levels. Our primary outcomes were inhospital mortality and length of hospital stay. Groups were dichotomized into those arriving to the ED via emergency medical services and those arriving independent of emergency medical services (controls).Results: Of 359 patients who met study inclusion criteria, 283 (79%) presented by emergency medical services. Two-thirds of the overall group (62%) was male; the average age was57±15 years. Patients presenting via emergency medical services were older than controls (58±14 years versus 52±17, diff= 6, 95%CI=3,10). Emergency medical services transports had lower initial lactate levels (5±4vs 6±4, diff=1,95%CI=0.1, 1.8) and were less likely to present with critically high, shock lactate levels greater than 4 (50% versus 66%, diff=16, 95%CI=0,32). Despite this difference in lactate levels, more emergency medical services patients presented with altered mental status (57% VS 30%, diff=27, 95%CI=9,42) and respiratory difficulty (66% with tachypnea VS 54%, diff=12, 95%CI=3,29). There were no differences between the groups on initial ED vital signs or blood glucose levels. There were no differences in the outcomes of length of hospital stay (10±15 versus 11±17) or mortality (32% versus 30%).Conclusion: Patients with severe sepsis transported by emergency medical services are older and have more overt signs of severity but lower lactate levels than those presenting independent of emergency medical services. Mode of ED arrival was not associated with initial vital signs or short-term mortality. Study Objectives: Sepsis is a leading cause of morbidity and mortality worldwide. This study is a retrospective review of quality improvement data gathered from a large teaching hospital since November 2009. The aim of this study was to compare outcomes between patients presenting by emergency medical services compared to those presenting directly to the emergency department (ED). Methods: We prospectively identified and reviewed all cases of severe sepsis admitted to the medical intensive care unit from the ED in the 2-year period between 11/1/09 and 10/1/11. Emergency medical services variables extracted were vital signs, blood glucose, presence of altered mental status and transport times. ED variables were initial ED vitals, blood glucose, presence of altered mental status and serum lactate levels. Our primary outcomes were inhospital mortality and length of hospital stay. Groups were dichotomized into those arriving to the ED via emergency medical services and those arriving independent of emergency medical services (controls). Results: Of 359 patients who met study inclusion criteria, 283 (79%) presented by emergency medical services. Two-thirds of the overall group (62%) was male; the average age was57±15 years. Patients presenting via emergency medical services were older than controls (58±14 years versus 52±17, diff= 6, 95%CI=3,10). Emergency medical services transports had lower initial lactate levels (5±4vs 6±4, diff=1,95%CI=0.1, 1.8) and were less likely to present with critically high, shock lactate levels greater than 4 (50% versus 66%, diff=16, 95%CI=0,32). Despite this difference in lactate levels, more emergency medical services patients presented with altered mental status (57% VS 30%, diff=27, 95%CI=9,42) and respiratory difficulty (66% with tachypnea VS 54%, diff=12, 95%CI=3,29). There were no differences between the groups on initial ED vital signs or blood glucose levels. There were no differences in the outcomes of length of hospital stay (10±15 versus 11±17) or mortality (32% versus 30%). Conclusion: Patients with severe sepsis transported by emergency medical services are older and have more overt signs of severity but lower lactate levels than those presenting independent of emergency medical services. Mode of ED arrival was not associated with initial vital signs or short-term mortality.