Volume of Emergency Department Admissions for Sepsis is Related to Inpatient Mortality: Results of a Nationwide Cross-sectional Analysis

Abstract

Although substantial research has been devoted to sepsis, it remains unclear if greater everyday experience with sepsis resuscitation in the emergency department (ED) leads to improved patient outcomes. The primary goal of this cross-sectional analysis was to examine whether there is an association between inpatient mortality and the annual volume of patients with sepsis admitted via EDs. In this cross-sectional analysis of the 2007 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 87,166 adult ED sepsis admissions from 551 hospitals were identified. Hospitals were categorized into quartiles based upon 2007 ED sepsis volume. Univariate statistics were used to determine the association between patient characteristics, hospital characteristics, and inpatient mortality with the volume of treated sepsis patients. Mortality was measured both by the overall inpatient mortality (death at any time during hospital admission) and early inpatient mortality (death within the first 2 days of admission) of sepsis patients. The overall inpatient sepsis mortality was 18.0%, and early mortality (2 days after admission) was 6.9%. After adjustment for co-morbidity and hospital-level factors, there was a significant inverse association between ED sepsis case volume and both early and overall inpatient mortality (p<0.001). Patients admitted via the ED to hospitals in the highest annual ED sepsis case volume quartile had lower rates of inpatient death (odds ratio [OR] 0.73; 95% CI 0.64–0.83; p<0.001) and lower odds of early inpatient death (OR 0.69; 95% CI 0.61– 0.80; p<0.001) when compared to patients admitted to hospitals in the lowest ED sepsis case volume quartile.