Abstract
IntroductionTo evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, particularly with regard to trends over time. We interrogated a high quality clinical database to examine trends in the incidence and mortality of severe sepsis over a nine-year period.MethodsAdmissions with severe sepsis occurring at any time within 24 hours of admission to critical care were identified to an established methodology using raw physiological data from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, containing data from 343,860 admissions to 172 adult, general critical care units in England, Wales and Northern Ireland between December 1995 and January 2005. Generalised linear models were used to assess changes in the incidence, case mix, outcomes and activity of these admissions.ResultsIn total, 92,672 admissions (27.0%) were identified as having severe sepsis in the first 24 hours following admission. The percentage of admissions with severe sepsis during the first 24 hours rose from 23.5% in 1996 to 28.7% in 2004. This represents an increase from an estimated 18,500 to 31,000 admissions to all 240 adult, general critical care units in England, Wales and Northern Ireland. Hospital mortality for admissions with severe sepsis decreased from 48.3% in 1996 to 44.7% in 2004, but the total number of deaths increased from an estimated 9,000 to 14,000. The treated incidence of severe sepsis per 100,000 population rose from 46 in 1996 to 66 in 2003, with the associated number of hospital deaths per 100,000 population rising from 23 to 30.ConclusionThe population incidence of critical care admission with severe sepsis during the first 24 hours and associated hospital deaths are increasing. These baseline data provide essential information to those wishing to evaluate the introduction of the Surviving Sepsis Campaign care bundles in UK hospitals.
Highlights
To evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, with regard to trends over time
Admissions with severe sepsis occurring at any time within 24 hours of admission to critical care were identified to an established methodology using raw physiological data from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, containing data from 343,860 admissions to 172 adult, general critical care units in England, Wales and Northern Ireland between December 1995 and January 2005
There was a slight decrease in the proportion of admissions with severe sepsis transferred in from another intensive care units (ICUs) (P = 0.003) and a corresponding increase in the proportion stepped-up from an high dependency units (HDUs) (P = 0.036); there was no change in the proportion managed on the ward by the critical care team prior to admission (P = 0.62)
Summary
To evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, with regard to trends over time. The published mortality associated with the disease has reduced slightly in the past 10 to 15 years, almost certainly a reflection of improved supportive clinical care, but still remains high (30% to 50%) [2]. This reduction is evident from comparative outcomes in placebo groups of large randomised studies in severe sepsis [3,4,5,6]. Recent treatment modalities that have established their efficacy in patients with severe sepsis include drotrecogin alfa (activated) [5] and early goal-directed therapy [7]. The widespread adoption of such evidence-based practice into clinical care has been disappointingly slow, despite the quantifiable benefits of a 6.1% absolute reduction in 28-day mortality with drotrecogin alfa
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