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Abstract

Introduction: The 2010 Nationwide Emergency Department Sample (NEDS) yields national estimates of emergency department (ED) visits in the United States. NEDS was constructed from merging State Emergency Department Database (capturing ED visits that did not result in admission to the same hospital) and State Inpatient Database (linking all ED visits admitted to the same hospital) from 28 participating states. NEDS 2010, the largest all-payer ED database available in the United States, contains information from over 28 million ED visits at 961 hospitals that approximate a 20% stratified sample of U.S. hospital-based EDs. By stratifying based on key hospital characteristics, NEDS provides a snapshot view of US hospital-based EDs. Methods: Design: Observational cohort study. Patients: With IRB approval we isolated all ED visits that were injury-related and resulted in an inpatient admission (n=2,413,384). NEDS identifies injuries by ICD-9 CM diagnosis code using a scheme recommended by a consensus report from the Safe States Alliance. We further delineated patients with ICD-9 diagnosis codes 995.90-995.94 for sepsis from the non-sepsis injury group. Results: Out of the estimated 128 million ED visits in the United States in 2010, 30.2 million were injury-related. The vast majority of patients were treated and released from the ED, but 2.4 million injury-related visits resulted in admissions to that same hospital. The most frequent injury mechanism was falls (1.0 million) but 37% of all admissions recorded more than one type of injury. Reviewing linked inpatient records for these visits, 3.2% had ICD-9 codes for sepsis. Sepsis patients were older than non-sepsis group (63.9 vs. 57.5 years old, p<0.0001) and more likely to be male (57% vs. 50%, p<0.0001). The length of stay was longer (13.3 vs. 5.0, p<0.0001) and inpatient charges were significantly greater ($126,321 vs. $42,870, p<0.0001) for sepsis than non-sepsis. The mortality rate was also significantly higher among sepsis patients (18.0% vs. 2.7%, p<0.0001). Using logistic regression analysis the following independent risk factors were identified: patients older than age 50 (odds ratio OR=1.9, CI: 1.8-2.1), male gender (OR=1.4, CI: 1.3-1.4), and presence of a chronic comorbid condition (such as diabetes, cancer or anemia etc. OR= 5.9, CI: 5.0-6.9). Fire (OR=1.4, CI: 1.0-1.8), injury involved with nature (OR=1.5, CI: 1.4-1.7), and suffocation (OR=4.2, CI: 3.7-4.7) all showed an increased incidence of sepsis. Conclusions: Sepsis is an expensive and often fatal complication of injury-related admissions in the United States. Based upon our findings, patients with specific injuries related to suffocation, nature or fire were more likely to develop sepsis. Older patients, males, and those with chronic conditions are also at higher risk. Development of sepsis increases resource utilization and contributes to poor outcomes.