Emergency Medicine Commons^™

Delays To Antibiotics In The Emergency Department And Risk Of Mortality In Children With Sepsis., Roni D. Lane, Troy Richardson, Halden F. Scott, Raina M. Paul, Fran Balamuth, Matthew A. Eisenberg, Ruth Riggs, W Charles Huskins, Christopher M. Horvat, Grant E. Keeney, Leslie Hueschen, Justin M. Lockwood, Vishal Gunnala, Bryan P. Mckee, Nikhil Patankar, Venessa Lynn Pinto, Amanda M. Sebring, Matthew P. Sharron, Jennifer Treseler, Jennifer J. Wilkes, Jennifer K. Workman

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Pediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.

OBJECTIVE: To determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from 51 US children's hospitals in the Improving Pediatric Sepsis Outcomes collaborative. Participants included patients aged 29 days to less than 18 years with sepsis recognized within 1 hour …

Clostridium Perfringens Sepsis From A Hepatic Abscess With Hemolysis And Renal Failure, Requiring Hemodialysis, Joel Collins Ii, Katelyn Courtney, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

The prognosis of sepsis caused by Clostridium perfringens is extremely poor, with a mortality rate of 70%-100%. Management includes antibiotic regimens specific to toxin production as well as source control via surgical or interventional mechanisms. We report a case of a 64-year-old male who presented with right upper quadrant (RUQ) abdominal pain and was diagnosed with Clostridium perfringens bacteremia with associated acalculous cholecystitis, hepatic abscess, and acute renal failure requiring hemodialysis. It is felt that early hemodialysis was an associated factor in the patient's survival.

Cellular Host Response Sepsis Test For Risk Stratification Of Patients In The Emergency Department: A Pooled Analysis, Hollis R. O'Neal, Roya Sheybani, Chadd K. Kraus, Wesley H. Self, Ajay M. Shah, Christopher B. Thomas, Henry T.K. Tse, Robert Scoggins

School of Medicine Faculty Publications

Objectives: Sepsis is one of the most common, costly, and misdiagnosed conditions in U.S. emergency departments (EDs). ED providers often treat on nonspecific signs, subjective suspicion, or presumption of infection, resulting in over- and undertreatment. An increased understanding of host response has opened a new direction for sepsis diagnostics. The IntelliSep test is a U.S. Food and Drug Administration–cleared cellular host response diagnostic that could help distinguish sepsis in ED settings. Our objective was to evaluate the potential of the cellular host response test to expedite appropriate care for patients who present with signs of infection. Methods: We performed a …

Validation Of A Novel, Rapid Sepsis Diagnostic For Emergency Department Use, Hollis R. O'Neal, Roya Sheybani, David R. Janz, Robert Scoggins, Tonya Jagneaux, James E. Walker, Daniel J. Henning, Elizabeth Rosenman, Simon A. Mahler, Hariharan Regunath, Christopher S. Sampson, D. Clark Files, Richard D. Fremont, Michael J. Noto, Erica E. Schneider, Wesley R. Shealey, Matthew S. Berlinger, Thomas C. Carver, Morgan K. Walker, Nathan A. Ledeboer, Ajay M. Shah, Henry T.K. Tse, Dino Dicarlo, Todd W. Rice, Christopher B. Thomas

School of Medicine Faculty Publications

OBJECTIVES: To assess the in vitro IntelliSep test, a microfluidic assay that quantifies the state of immune activation by evaluating the biophysical properties of leukocytes, as a rapid diagnostic for sepsis. DESIGN: Prospective cohort study. SETTING: Five emergency departments (EDs) in Louisiana, Missouri, North Carolina, and Washington. PATIENTS: Adult patients presenting to the ED with signs (two of four Systemic Inflammatory Response Syndrome criteria, where one must be temperature or WBC count) or suspicion (provider-ordered culture) of infection. INTERVENTIONS: All patients underwent testing with the IntelliSep using ethylene diamine tetraacetic acid-anticoagulated whole blood followed by retrospective adjudication for sepsis by …

Variability In Provider Assessment Of Sepsis And Potential Of Host Response Technology To Address This Dilemma—Results Of An Online Delphi Study, Chadd K. Kraus, Hollis R. O’Neal, Nathan A. Ledeboer, Todd W. Rice, Wesley H. Self, Richard E. Rothman

School of Medicine Faculty Publications

Potentially septic patients have a huge clinical and economic impact on hospitals and often present to the emergency department (ED) with undifferentiated symptoms. The triage of these patients is complex and has historically relied heavily upon provider judgment. This study aims to evaluate the consistency of provider judgment and the potential of a new host response sepsis test to aid in the triage process. A modified Delphi study involving 26 participants from multiple specialties was conducted to evaluate provider agreement about sepsis risk and to test proposed actions based on the results of a sepsis test. The participants considered case …

Role Of Soluble Urokinase Type Plasminogen Activator Receptor (Supar) In Predicting Mortality, Readmission, Length Of Stay And Discharge In Emergency Patients: A Systematic Review And Meta Analysis, Syeda Tayyaba Rehan, Hassan Ul Hussain, Eman Ali, Kanwal Ashok Kumar, Shehroze Tabassum, Muhammad Hasanain, Asim Shaikh, Gibran Ali, Zohaib Yousaf, Muhammad Sohaib Asghar

Section of Internal Medicine

Background: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED.
Methods: We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to …

Are Patients With An International Classification Of Diseases, 10th Edition Discharge Diagnosis Code For Sepsis Different In Regard To Demographics And Outcome Variables When Comparing Those With Sepsis Only To Those Also Diagnosed With Covid-19 Or Those With A Covid-19 Diagnosis Alone?, David F. Gaieski, Jumpei Tsukuda, Parker Maddox, Michael Li

Department of Emergency Medicine Faculty Papers

OBJECTIVES: We analyzed whether patients with the International Classification of Diseases, 10th Edition (ICD-10) discharge diagnosis code for sepsis are different in regard to demographics and outcome variables when comparing those with sepsis only to those also diagnosed with COVID-19 or those with a COVID-19 diagnosis alone.

DESIGN: Retrospective cohort study.

SETTING: Nine hospitals in an academic health system.

PATIENTS: Patients with a final ICD-10 discharge diagnostic code for sepsis only, a diagnosis of COVID-19-only, or a final sepsis ICD-10 discharge code + a diagnosis of COVID-19 admitted to the hospital were analyzed for demographic and outcome differences between the …

An Unusual Ed Case: Spontaneous Necrotizing Fasciitis Presenting As Hypoxic Pneumonia, Chetna Thawani, Kishan Patel

Rowan-Virtua Research Day

We present a case of necrotizing fasciitis initially presenting as septic hypoxic pneumonia, and discuss imaging modalities and diagnostic evaluation. Necrotizing soft tissue infection (NSTI) is a rapidly progressive surgical emergency with a mortality rate of 30%. In approximately 80% of cases, it is introduced through a break in the skin. It can also occur after any invasive procedure or surgery. It is most commonly associated with skin flora including staph and strep, though polymicrobial infections are most common. It usually presents with signs of systemic infection, including fever, chills, sepsis, altered mental status - and signs of cutaneous involvement …

When Constipation Becomes Lethal: Septic Shock Induced By Stercoral Colitis In A 77-Year-Old Female, Anna Delancy, Nicholas Tomasello, Joan Wiley, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Stercoral colitis is a form of colitis caused by fecal impaction distending the colon and causing fecaloma formation. Fecalomas lead to pressure necrosis of the colon and eventual perforation. The increased intraluminal pressure from the distention of the colon causes vascular compromise and ischemia. The most common locations of necrosis are in the sigmoid colon and rectum . When progressed to perforation, the mortality rate is as high as 60%. The most common cases of stercoral colitis occur in nursing home patients, mentally impaired patients, or those with chronic constipation. Here we describe an unusual case of stercoral colitis causing …

Investigating The Effectiveness Of Prehospital Recognition And Administration Of Intravenous Antibiotics In Septic Patients, Laura Keane, Ian Peterson

Physician Assistant Capstones, 2020-current

Objective: To compare the 30-day mortality rate of suspected sepsis patients who received prehospital (Emergency Medical Services- EMS) antibiotic administration in an ambulance as compared to antibiotic administration in the hospital. Design: Systematic literature review. Methods: Research was conducted in PubMed and Google Scholar with the search terms: sepsis, antibiotics, prehospital, EMS, ambulance. The 3 articles selected were chosen after removing articles not from a randomized control trial, no antibiotic administration, and not a free article. Results: From our meta-analysis of the three studies, we concluded that providing antibiotics before arriving at the hospital for patients with suspected septic infections. …

Sepsis Inservice And Video At An Urban Hospital In California, Angela T. Ho

Master's Projects and Capstones

The emergency department at an urban hospital in California was performing below institutional goals related to sepsis protocols over the past few months. This intervention was targeted at nurses and was composed of a PowerPoint in-service on compliance to SEP-1 protocols and follow-along video on using the correct sepsis order set and documentation in the electronic health record (EHR). Goals included increased compliance to the SEP-1 protocol and documentation, (2) reduced time between the onset of symptoms, recognition, and intervention, (3) decline in sepsis rates and mortality rates, and (4) lower cost of care. Data was collected from the EHR …

Advanced Triage Protocol: The Role Of An Automated Lactate Order In Expediting Rapid Identification Of Patients At Risk Of Sepsis In The Emergency Department, Andrew Baum, Brendan G Carr, Sarah M Perman, Jennifer Barger, Munish Goyal, David F. Gaieski

Department of Emergency Medicine Faculty Papers

We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.

Design: Prospective cohort study.

Setting: Seven hundred-bed tertiary care hospital with ≅65,000 patient visits/yr.

Patients: Patients presenting to emergency department (ED) triage who met the following criteria: greater than or equal to two of the three systemic inflammatory response syndrome criteria assessable in triage, a chief complaint suggestive of infection, emergency severity index 2 or 3, and ambulatory to ED.

Interventions: A computer-generated lactate order was created, staff education and resources increased, and point-of-care lactate …

Outcomes For Patients With Congestive Heart Failure And Chronic Kidney Disease Receiving Fluid Resuscitation For Severe Sepsis Or Septic Shock, Melany Wiczorek, Ronny Otero, Steven Knight, Kaitlin Ziadeh, James Blumline, Zachary Rollins

Posters

INTRODUCTION
Sepsis core measures are an integral part of sepsis treatment. Current fluid administration guidelines consist of administering at least 30cc/kg of intravenous fluids (IVF) per ideal body weight (IBW) within the first three hours of sepsis diagnosis regardless of pre-existing comorbidities at risk for fluid overload. This study aims to evaluate the outcomes of patients with a history of congestive heart failure (CHF) and/or chronic kidney disease (CKD) who receive fluid resuscitation for the management of severe sepsis or septic shock.

The Impact Of Early Goal Directed Sepsis Bundle Sets In The Emergency Department And The Impact Of Sep-1 Compliance Rates, Christie L. Ferrari

DNP Scholarly Projects

Sepsis is a medical emergency that is prevalent throughout hospitals everywhere. Due to the growing crisis, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Surviving Sepsis Campaign (SSC) adopted core measures for sepsis (SEP-1) which aim at improving overall compliance of evidence-based treatment standards for sepsis. The purpose of this Doctor of Nursing Practice (DNP) project was to determine if incorporating early goal directed sepsis bundles in a rural Midwestern ED was effective in increasing compliance with SEP-1 rates. The secondary purpose evaluated how nursing knowledge, awareness, and compliance with sepsis bundles affects SEP-1 compliance rates. …

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

MSU Graduate Theses

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Pediatric Sepsis-Development Of A Clinical Pathway For The Pediatric Emergency Department, Roslyn Lampkin-Smiley

Student Scholarly Projects

Globally, various researchers have suggested that sepsis is one of the most prominent causes of infant fatalities. Since 2004, countless guidelines have been developed to assist in the early identification and management of sepsis. The PICOT question that guided this project was: Does the implementation of a pediatric sepsis clinical pathway, compared with the standard protocol in emergency departments, decrease delays in treatment times of patients presenting with sepsis? Researchers have suggested that early recognition and interventions for septic patients can result in decreased mortality rates. A pediatric sepsis clinical pathway was implemented during this project. The pathway alerted staff …

Knowledge, Attitudes, Practices And Perceived Barriers Of Emergency Health Care Providers Regarding Sepsis And Septic Shock In A Tertiary Care Centre: A Cross-Sectional Study, Madiha Ismail, Umaira Aftab, Kiran Azizi, Badar Afzal Khan

Department of Emergency Medicine

This study aimed to assess knowledge, attitudes, practices, and perceived barriers of emergency healthcare providers regarding the management of sepsis and septic shock. This cross-sectional study was conducted in the Emergency Department of Aga Khan University Hospital, Karachi, Pakistan from August to October 2017. A total of 53 healthcare providers participated in the study. Overall, 42(79%) of the participants demonstrated correct knowledge of the sepsis bundle. The most common barrier reported in the compliance of the sepsis bundle was a shortage of staff (62%), followed by delayed presentation of patients (58%) and overcrowding (42%). Furthermore, better staffing was perceived by …

The Effect Of Medical Nutrition Therapy On Weight Loss, Ayesha Baig, Hannah Kostan, Cynthia Cheng

Phase 1

Introduction: In this retrospective study, we evaluated the effects of Jefferson’s medical nutrition therapy (MNT) program on weight loss. We anticipate that participation in the MNT program will lead to an improvement in weight and metabolic syndrome parameters.

Methods: We selected a convenience sample of 10 participants with BMI > 25 for this pilot retrospective chart review. Subjects were screened for various exclusion criteria such as past bariatric surgery, heart failure, malignancy, renal dialysis, and uncontrolled conditions such as hypothyroidism, anemia, or B12 deficiency. Weight measurements were collected from EPIC records starting from baseline, defined as 3 months prior to initiation …

Inpatient Hospital Performance Is Associated With Post-Discharge Sepsis Mortality., Nicholas M. Mohr, Alexis M. Zebrowski, David F. Gaieski, David G. Buckler, Brendan G. Carr

Department of Emergency Medicine Faculty Papers

BACKGROUND: Post-discharge deaths are common in patients hospitalized for sepsis, but the drivers of post-discharge deaths are unclear. The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes.

METHODS: Retrospective cohort study of age-qualifying Medicare beneficiaries with sepsis hospitalization between January 2013 and December 2014. Hospital survivors were followed for 180-days post-discharge, and mortality, readmissions, and new admission to skilled nursing facility were measured. Inpatient hospital-specific sepsis risk-adjusted mortality ratio (observed: expected) was the primary exposure.

RESULTS: A total of 830,721 …

A Reevaluation Of The Importance Of Timing To Antibiotic Administration In Patients With Sepsis And Septic Shock In The Emergency Department, Melissa Yoon

Capstone Showcase

Sepsis is a life threatening organ dysfunction that is caused by the body’s dysregulated response to an infection. A crucial component of treatment includes intravenous antibiotic administration and is recommended within 1 hour of suspected sepsis. However, research conducted over the past two decades have produced mixed results regarding the relationship between mortality rates and this 1 hour time limit. In light of issues such as increasing antibiotic resistance and limited resources in emergency departments, this study reviewed current literature to critically evaluate the effects of modest delays in antibiotic administration in sepsis and septic shock. The studies suggest that …

Sepsis Education And Training In Medical School, Shayan Ghiaee, Dimitrios Papanagnou, Md, David F. Gaieski, Md

Phase 1

Purpose: According to the National Institutes of Health, severe sepsis strikes more than one million Americans every year. Despite the extensive research that has gone into creating the different risk stratification tools for sepsis, there is still a fifteen to thirty percent mortality rate among patients diagnosed with sepsis. We believe this is due to a lack of robust education and training of medical students in sepsis identification, and thus, the purpose of this study was to determine the extent of training and education of medical students in the identification and treatment of sepsis.

Methods: This study is aimed at …

Update To The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: Statistical Analysis Plan For A Prospective, Multicenter, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., Christopher J. Lindsell, Anna Mcglothlin, Samuel Nwosu, Todd W. Rice, Alex Hall, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Jeremiah S. Hinson, Michael H. Hooper, James C. Jackson, Gabor D. Kelen, Mark Levine, Greg S. Martin, Richard E. Rothman, Jonathan E. Sevransky, Kert Viele, David W. Wright, David N. Hager

Department of Emergency Medicine Faculty Papers

BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock.

METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multicenter, double-blind, adaptive sample size, randomized, placebo-controlled trial designed to test the efficacy of combination therapy with vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) given every 6 h for up to 16 doses in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. The primary outcome is ventilator- and vasopressor-free days with mortality as the key secondary outcome. …

Surviving Sepsis: A Treatment Process Improvement In High Volume Emergency Departments, Brittney Burns

Doctor of Nursing Practice

Sepsis is the 3rd leading cause of death in the United States, accounting for approximately 270,000 deaths annually (CDC, 2017). It is the number one cause of death in hospitals, the number one cause of hospital readmissions, and the costliest diagnosis in the hospital setting (Fingar & Washington, 2015; Torio & Andrews, 2015). This quality improvement project aimed to increase the percentage of antibiotics administered within 1 hour for sepsis patients. Mortality rates significantly decrease when this goal is met (Howell & Davis, 2017). There is an 8% increase in mortality risks with every hour that passes with elevated lactic …

Listen To Your Heart, Or At Least Theirs: Maintaining A High Index Of Suspicion For Infective Endocarditis, Mollie Powell Do, Mahesh Setty Md

Emergency Medicine

After an endothelial injury, a fibrin and platelet cap forms. This cap is typically sterile but in times of infection can become colonized by microbes leading to a vegetation. When this occurs on the endothelium of the heart, it is termed infective endocarditis (IE). IE is a difficult diagnosis to make in the ED. The symptoms are vague. Classic exam findings are often absent, murmur auscultation can be challenging and there is not a single diagnostic test. A delayed or missed diagnosis can be fatal; therefore, it is essential that ED physicians maintain a high index of suspicion in high …

The Vitamin C, Thiamine And Steroids In Sepsis (Victas) Protocol: A Prospective, Multi-Center, Double-Blind, Adaptive Sample Size, Randomized, Placebo-Controlled, Clinical Trial., David N. Hager, Michael H. Hooper, Gordon R. Bernard, Laurence W. Busse, E. Wesley Ely, Alpha A. Fowler, David F. Gaieski, Alex Hall, Jeremiah S. Hinson, James C. Jackson, Gabor D. Kelen, Mark Levine, Christopher J. Lindsell, Richard E. Malone, Anna Mcglothlin, Richard E. Rothman, Kert Viele, David W. Wright, Jonathan E. Sevransky, Greg S. Martin

Department of Emergency Medicine Faculty Papers

BACKGROUND: Sepsis accounts for 30% to 50% of all in-hospital deaths in the United States. Other than antibiotics and source control, management strategies are largely supportive with fluid resuscitation and respiratory, renal, and circulatory support. Intravenous vitamin C in conjunction with thiamine and hydrocortisone has recently been suggested to improve outcomes in patients with sepsis in a single-center before-and-after study. However, before this therapeutic strategy is adopted, a rigorous assessment of its efficacy is needed.

METHODS: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a prospective, multi-center, double-blind, adaptive sample size, randomized, placebo-controlled trial. It will enroll …

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for …

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the alert, …

Protocol Based Screening Tools To Identify Sepsis Patients Transported By Emergency Medical Services, Isaiah Moser

Honors Undergraduate Theses

Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients’ outcome. Results found included that …

Hydrocortisone, Vitamin C And Thiamine For The Treatment Of Severe Sepsis And Septic Shock: A Retrospective Before-After Study, Paul E. Marik, Vikramjit Khangoora, Racquel Rivera, Michael H. Hooper, John Catravas

Bioelectrics Publications

BACKGROUND: The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries.

METHODS: In this retrospective before-after clinical study, we compared the outcome and clinical course of consecutive septic patients treated with intravenous vitamin C, hydrocortisone and thiamine during a 7-month period (treatment group) compared to a control group treated in our ICU during the preceding 7 months. The primary outcome was hospital survival. A propensity score was generated to adjust the primary outcome.

FINDINGS: There were 47 patients in both treatment and control groups with no …

National Estimates Of Emergency Department Visits For Pediatric Severe Sepsis In The United States, Sara Singhal, Mathias W. Allen, John-Ryan Mcannally, Kenneth S. Smith, John P. Donnelly, Henry E. Wang

Emergency Medicine Faculty Publications

Objective. We sought to determine the characteristics of children presenting to United States (US) Emergency Departments (ED) with severe sepsis.

Study design. Cross-sectional analysis using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). Using triage vital signs and ED diagnoses (defined by the International Classification of Diseases, Ninth Revision codes), we identified children(triage fever or ICD-9 infection) and organ dysfunction (triage hypotension or ICD-9 organ dysfunction).

Results. Of 28.2 million pediatric patients presenting to US EDs each year, severe sepsis was present in 95,055 (0.34%; 95% CI: 0.29-0.39%). Fever and respiratory infection were the most common indicators of …