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Studies back benefit of tackling sepsis early in A&E

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Two US studies have suggested initially treating sepsis in accident and emergency, prior to patients being moved to intensive care, in order to speed up identification and improve outcomes.

One group of researchers found that a “sepsis and shock response team” based in the emergency department reduced mortality, while a second study found no increased mortality risk when patients with sepsis were stabilised in A&E.

“Identification and immediate treatment may positively impact survival in sepsis – no matter the hospital location of that patient”

Aruna Jahoor

Researchers from the Mayo Clinic in Florida formed a multi-disciplinary sepsis and shock response team (SSRT) to help alert emergency department clinicians when the condition was suspected.

An automated electronic sepsis alarm was introduced for early recognition, which alerted the SSRT to attend and manage patients with suspected sepsis or shock.

It improved the both compliance with standard care measures and overall mortality, said the researchers.

The study reviewed data on 167 patients with sepsis admitted to one hospital over 12 months, comparing outcomes for the periods before and after the SSRT was introduced.

Results showed that the observed and expected sepsis mortality index improved from 1.38 pre-SSRT to 0.68 post-SSRT implementation.

“Implementation of automatic electronic alerts followed by systematic assessment and early intervention will improve compliance with diagnosis and treatment protocols,” said lead author Dr Moreno Franco.

“It will also improve the standard of care measures and outcomes of patients with severe sepsis and septic shock,” he added.

Meanwhile, researchers from Texas found no increased risk of mortality for patients with severe sepsis who were stabilised in the A&E prior to intensive care admission.

The review, which involved 164 patients, revealed that the sickest were triaged quickly to the intensive care unit and had a shorter A&E length of stay.

Additional variables that may impact mortality in severe sepsis were also analysed, including A&E triage to antibiotic time, triage to lactate time, lactate clearance, A&E length of stay, and variations in volume of intravenous fluids.

Most variables did not show a significant difference in outcomes, said the study authors. The exception was initial lactate value and shorter length of stay in the A&E, both of which indicated sicker patients and were tied to higher mortality rates.

“Our study found that the sickest patients were more quickly triaged to the ICU. Those patients who were less sick and kept in the ED for longer time had lower mortality,” said lead researcher Dr Aruna Jahoor, from the Baylor Scott and White Health and Texas A&M Health Science Center College of Medicine.

“These results suggest that identification and immediate treatment may positively impact survival in sepsis – no matter the hospital location of that patient,” she added.

Both studies were published yesterday in the journal Chest and are due to be presented next week at the annual conference of the American College of Chest Physicians in Montréal.

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