Sepsis Major Cause of True Deterioration
SUMMARY:
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Sepsis is a major cause of morbidity and mortality globally.
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Early identification and treatment of any causes of acute deterioration outside the ICU will help improve clinical outcomes.
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Sepsis, either alone or as part of multiple causes, is the most common cause of deterioration in non-ICU patients.
REVIEW:
Churpek MM, et al. Critical Care Explorations 2024: DOI: 10.1097/CCE.0000000000001161.
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Clinical deterioration has been previously associated with increased respiratory rates.
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However, the medical conditions causing this deterioration have been less well described.
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Retrospective observation review of non-ICU hospital admissions from 2007 to 2020
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Electronic Cardiac Arrest Risk Triage score (eCART) was calculated in all patients.
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Uses 33 parameters (vital signs, laboratory data)
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Predicts patients at highest risk of deterioration
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Previously validated to be more accurate than MEWS and NEWS to predict cardiac arrest, death and ICU admission
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Deterioration via eCART score defined as scores in the 95th percentile for each admission
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919,319 admissions
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91,131 (10%) had eCART scores indicating deterioration
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Manual chart review by clinicians to determine true deterioration
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4,000 randomly selected admissions were reported on
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RESULTS:
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983 (25%) required ICU admission
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474 (12%) died during admission
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True deterioration determined in 2,484 (62%) of the 4,000 patients
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- Causes of True Deterioration
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- Sepsis was most common cause of true deterioration in these non-ICU patients (n=1,024 41%).
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- Next most common causes were: Arrhythmia (19%); Heart Failure (13%); Hypoxemic Respiratory Failure (10%); Electrolyte Abnormality (9%).
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- Most Common Co-Occurring causes of deterioration
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- 7 of the top 11 co-occurring causes were with sepsis.
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- Sepsis & Hypoxemia (n=127 5%)
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- Sepsis & Arrhythmia (n=85 3%)
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- Sepsis & Heart Failure (n=83 3%)
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- Present On Admission vs Hospital Acquired
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- Sepsis was the most common cause of true deterioration that was present on admission (n=863 48%).
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- Arrhythmias were the most common cause of true deterioration which was hospital acquired (n=183 29%).
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- Sepsis was number 2 (n=140 22%)
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- True deterioration due to causes present on admission had a higher in-patient mortality rate compared to hospital acquired deterioration (15.4% vs 10.6% p=0.003).
- True deterioration due to causes present on admission had a higher in-patient mortality rate compared to hospital acquired deterioration (15.4% vs 10.6% p=0.003).
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CONCLUSIONS:
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Sepsis is the most common cause of clinical deterioration.
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Hospital acquired sepsis was the second most common cause of clinical deterioration.
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Sepsis was the most common cause of clinical deterioration when combinations of 2 disease states were found.
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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.
To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.