Some patients (pts) with “sepsis”, as classically defined, are nonetheless “treated and released” (Tx/Rel) from the emergency department (ED). [“Sepsis” means at least 2 “SIRS” criteria with an infectious diagnosis (dx)]. Careful ED physicians (EDPs) probably use “physician gestalt” to identify septic pts for this strategy. Prior peer-reviewed outcomes studies of septic pts have included only those hospitalized. Thus, no peer-reviewed literature exists to support an ED “Tx/Rel” strategy for any septic pts. We tested the hypothesis that the 95% CI for 7-day (d) mortality of septic pts Tx/Rel from the ED with a dx of pneumonia (PNEU), influenza (INF) pyelonephritis (PYELO), Urinary Tract Infection (UTI) or undifferentiated sepsis (SEP) includes 0%. We tracked the short term outcomes (STO) of 7-d & 30-d mortality, & 7-d & 30-d returns for ED care. Search of the Social Security Death Index verified a lack of short-term (<30 d) mortality among pts who did not return to our ED for any subsequent care. SIRS scores, not qSOFA scores, plus one of these 5 infectious dx, were used to identify the study group with sepsis, because qSOFA score is a prognostic tool, validated in an Intensive Care Unit (ICU) setting, & because a valid prognostic study requires all pts to have a correct dx upon study entry. Thus, qSOFA is a tool unsuitable for identifying septic pts in the ED, because: 1) Use of qSOFA for diagnostic purposes would require “circular reasoning” & 2) An ED environment differs from ICUs where qSOFA was validated. *Between 1/1/2017 and 12/31/2018, 2677 patients were Tx/Rel from a busy tertiary hospital ED (2018 pt volume 59,788) with a dx of PNEU, INFL, PYELO, UTI or SEP. Of these, 1067 patients were “SIRS-positive” at ED arrival. *The 7-d and 30-d mortality of these 1067 pts was zero (95% CI 0-0.28%). Thus, these pts were safely Tx/Rel. 4/1067 returned to the ED within 30d for an unrelated reason. 17/1067 returned with a chief complaint (CC) apparently related to the 1st visit, but without evidence of decline of clinical status; 13/17 within 7d. All 17 were again Tx/Rel. 23/1067 pts returned to the ED within 30d due to evidence of decline or failure to improve as expected, of whom 1 returned beyond 7d. All 23 had a change in the therapeutic plan implemented, such as administration of oxygen and/or change of antibiotic. 13/23 were admitted to hospital at time of the 2nd ED visit, none to an ICU, & 12/13 within 7d. 10/23 were again Tx/Rel. Characteristics (Age, Sex, Dx, SIRS & qSOFA scores of those 23 with objective evidence of need to return to the ED will be presented at the Forum. Only 9/1067 SIRS+ pts had initial qSOFA scores of 2 or 3. ED physicians can safely Tx/Rel selected septic patients, apparently via “physician gestalt,” with very low risk of short-term mortality. Occasionally, septic pts Tx/Rel from an ED will deteriorate or fail to improve after discharge, demonstrating a need for clear “ED return precautions.”
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