Delayed Sepsis Care Increases In-Hospital Mortality Risk

Faster completion of a 3-hour sepsis care protocol and initiation of antibiotic treatment was found to improve sepsis in-hospital mortality outcomes, according to the findings of a recent study.

The study included data from 49,331 patients with sepsis and septic shock who were admitted to hospitals from April 1, 2014 to June 20, 2016. Sepsis protocol was initiated for all patients within 6 hours after arrival in the emergency department and all items were completed within 12 hours, including blood cultures, broad-spectrum antibiotic agents, and lactate measurement. Researchers assessed the time to completion of the 3-hour bundle and risk-adjusted mortality, as well as the time to administration of antibiotics and completion of an initial bolus of intravenous fluid.
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A total of 40,696 (82.5%) patients had the 3-hour bundle completed within 3 hours, (median time to completion was 1.3 hours). In addition, the median time to the administration of antibiotics was 0.95 hours, and the median time to completion of fluid bolus was 2.56 hours.

Completion of the bundle between 3 and 12 hours increased a patient’s risk of in-hospital mortality by 14% compared with patients who had the bundle completed in 3 hours. Patients who had antibiotics administered between 3 and 12 hours also had a 14% increase in in-hospital mortality risk. However, a longer time to complete bolus intravenous fluids was not associated with in-hospital mortality risk.

“Our findings support an association between time to treatment and outcome among patients with sepsis or septic shock treated in the emergency department during a statewide initiative mandating protocolized care,” the researchers concluded.

“If the relationship is causal, prompt recognition and faster treatment of sepsis and septic shock in the context of emergency care may reduce the incidence of avoidable deaths.”

—Melissa Weiss

Reference:

Seymour CW, Gesten F, Prescott HC, et al. Time to treatment and mortality during mandated emergency care for sepsis [published online May 21, 2017]. N Engl J Med. doi:10.1056/NEJMoa1703058.