SEPSIS IN THE NATIVE AMERICAN POPULATION

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The first purpose of this epidemiological evaluation was to determine the prevalence of sepsis or septic shock as defined by Sepsis-2 or Sepsis-3 criteria in the emergency department of a rural hospital in the United States serving a Native American population. The second purpose was to identify characteristics, causes, management and risk factors for sepsis in this population. METHODS: A retrospective chart review was performed. All emergency department encounters for the calendar year of 2018 were pre-screened broadly by a physician for transfer or admission diagnoses that may have underlying sepsis and excluded diagnoses such as assault, trauma or suicidal ideation that were unlikely to. These encounters were then evaluated to determine if the patient met Sepsis-2 or Sepsis-3 criteria for sepsis or septic shock during their emergency encounter. If an encounter met criteria, then it was selected for chart extraction. The full chart extraction included demographic, laboratory, clinical, management, 60 and 30 day mortality, and multiple risk factor data. The laboratory data included all elements of a SOFA score while clinical data included all basic vital signs and management data included but was not limited to time to antibiotics, volume of fluid and whether the provider identified sepsis. Risk factors assessed included but was not limited to alcohol use, obesity, diabetes, and recent antibiotic use. There were fifty-four individual elements extracted from each chart. Then, a comparison group of one hundred patients who presented to the emergency department but did not have sepsis was created. Demographic, mortality and risk factor data were collected from this group. RESULTS: There were 1,716 total admission or transfers for patients the age of 18 or older. Of those, 479 met Sepsis-2 or Sepsis-3 criteria during the emergency department encounter. This accounted for 27.9% of all admission or transfers in the calendar year of 2018 from this rural hospital serving a Native American population. Further data analysis on the demographic, laboratory, clinical, management, mortality data and relative risk for a variety of factors is underway. CONCLUSIONS: There is a strikingly larger portion of emergency department admissions and transfers met sepsis criteria in this rural hospital than has been previously described in the United States at large. Previous recent studies of clinical data from U.S. hospital admission have indicated that approximately ∼6% of all hospital admissions in the U.S. meet sepsis criteria. CLINICAL IMPLICATIONS: This markedly higher rate of sepsis upon admission or transfer from a rural emergency department merits further evaluation to explore why this rural and Native American population is disproportionately affected by sepsis. The pending data analysis of this study will provide further important descriptive data to better understand this high burden. DISCLOSURES: No relevant relationships by Hana Bakalli, source=Web Response No relevant relationships by Ryan Close, source=Web Response No relevant relationships by Kamellia Kellywood, source=Web Response