“Septic” patients (pts), as classically defined, have at least 2 Systemic Inflammatory Response Syndrome (SIRS) criteria + an infectious diagnosis (inf dx). Some septic pts are deliberately “treated and released” (Tx/Rel) from an Emergency Department (ED), probably based upon “physician gestalt.” Prior peer-reviewed studies of septic pts’ outcomes have been limited to hospitalized pts; mostly those in an Intensive Care Unit (ICU). Thus, no peer-reviewed literature exists to provide clinical or medicolegal support for any ED “Tx/Rel” strategy, when applied to septic pts. We tested the primary hypothesis that the 95% CI for 7-day (d) mortality (7dMort) & 30d mortality (30dMort) of septic pts Tx/Rel from the ED with an inf dx of Pneumonia (PNEU), Cellulitis or Abscess (SKIN), or UTI or Pyelonephritis (PYELO) includes 0%. We performed an 18 mo retrospective study of adults in an urban ED with an annual volume exceeding 80,000 pts. Secondary hypotheses were that short-term outcomes (STO) of 72hr & 30d ED returns related to the first ED visit, and the STO of 7d & 30d ED returns that result in hospital admission, also are very rare events for this pt cohort. Searching the Social Security Death Index (SSDI) confirmed lack of 7dMort or 30dMort. Age, vital signs, chief complaint, white blood cell count & discharge diagnosis data were collected. SIRS scores at least 2 plus a dx of PNEU, UTI, PYELO or SKIN identified the septic group studied. SIRS, not qSOFA defined the septic group; qSOFA score is an ICU-validated PROGNOSTIC tool. A valid PROGNOSTIC tool requires all pts to have a correct dx upon study entry. Principles of evidence-based medicine (EBM) lead inextricably to two justifications NOT to use qSOFA to define sepsis. These include 1) Use of qSOFA for ED diagnostic purposes would require “circular reasoning” & 2) An ED environment differs markedly from ICUs in which qSOFA was validated. *227 Tx/Rel septic pts included those with SKIN (31), PYELO (38), PYELO (111) or PNEU (47). *The 7dMort and 30dMort were 0/227 (0%) (95% CI 0-1.3%). *33/227 (13.3%) returned to the ED within 30 d with a similar chief complaint, mostly between 72 hr. & 30 d. after the initial ED visit. *4/33 were admitted for inpatient care within 30 d.; only 1 of these 4 patients’ admitting diagnosis was related to their initial ED chief complaint. Prior outcomes studies have overlooked study of septic pts of the type included in this study. ED physicians successfully identified pts with sepsis, as classically defined, to be Tx/Rel from the ED. Low risk existed for 7dMort or 30dMort, or need for admission to hospital for a reason related to the initial visit. Occasional pts will deteriorate or fail to improve, demonstrating that clear “ED return precautions” are important. No clinical strategy is foolproof, but we provide evidence to help support medicolegal defense of physicians who, using a supportable clinical rationale, Tx/Rel a septic pt with an inf dx after an episode of ED care.
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