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Jouffroy R, Djossou F, Neviere R, Jaber S, Vivien B, Heming N, Gueye P. The chain of survival and rehabilitation for sepsis: concepts and proposals for healthcare trajectory optimization. Ann Intensive Care 2024; 14:58. [PMID: 38625453 PMCID: PMC11019190 DOI: 10.1186/s13613-024-01282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
This article describes the structures and processes involved in healthcare delivery for sepsis, from the prehospital setting until rehabilitation. Quality improvement initiatives in sepsis may reduce both morbidity and mortality. Positive outcomes are more likely when the following steps are optimized: early recognition, severity assessment, prehospital emergency medical system activation when available, early therapy (antimicrobials and hemodynamic optimization), early orientation to an adequate facility (emergency room, operating theater or intensive care unit), in-hospital organ failure resuscitation associated with source control, and finally a comprehensive rehabilitation program. Such a trajectory of care dedicated to sepsis amounts to a chain of survival and rehabilitation for sepsis. Implementation of this chain of survival and rehabilitation for sepsis requires full interconnection between each link. To date, despite regular international recommendations updates, the adherence to sepsis guidelines remains low leading to a considerable burden of the disease. Developing and optimizing such an integrated network could significantly reduce sepsis related mortality and morbidity.
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Affiliation(s)
- Romain Jouffroy
- Intensive Care Unit, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne Billancourt, France.
- Centre de recherche en Epidémiologie et Santé des Populations - U1018 INSERM - Paris Saclay University, Paris, France.
- EA 7329 - Institut de Recherche Médicale et d'Épidémiologie du Sport - Institut National du Sport, de l'Expertise et de la Performance, Paris, France.
- Service de Médecine Intensive Réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique - Hôpitaux de Paris, and Paris Saclay University, Saclay, France.
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Guyane and Laboratoire Ecosystèmes Amazoniens et Pathologie Tropicale EA 3593, Centre Hospitalier de Cayenne, Université de Guyane, Cayenne, France
| | - Rémi Neviere
- Service des Explorations Fonctionnelles Centre Hospitalier Universitaire de Martinique et UR5_3 PC2E Pathologie Cardiaque, toxicité Environnementale et Envenimations (ex EA7525, Université des Antilles, Antilles, France
| | - Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, University of Montpellier, INSERM U1046, Centre Hospitalier Universitaire Montpellier, Montpellier, 34295, France
| | - Benoît Vivien
- Service d'Anesthésie Réanimation, SAMU de Paris, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicholas Heming
- Department of Intensive Care, Raymond Poincaré Hospital, Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), APHP University Versailles Saint Quentin - University Paris Saclay, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, Garches, 92380, France
| | - Papa Gueye
- SAMU 972, Centre Hospitalier Universitaire de Martinique, Fort-de-France Martinique, University of the Antilles, French West Indies, Antilles, France
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Born S, Fleischmann-Struzek C, Abels W, Piedmont S, Neugebauer E, Reinhart K, Toubekis E, Wegwarth O, Schwarzkopf D. Most patients with an increased risk for sepsis-related morbidity or death do not recognize sepsis as a medical emergency: results of a survey study using case vignettes. Crit Care 2023; 27:446. [PMID: 37978408 PMCID: PMC10655489 DOI: 10.1186/s13054-023-04733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sepsis is a medical emergency with potentially life-threatening consequences. Patients play a crucial role in preventing and recognizing sepsis at an early stage. The understanding of risk groups' sepsis knowledge and their ability to use this knowledge to recognize sepsis as an emergency is incomplete. METHODS We conducted a cross-sectional survey in Germany and included a sample of 740 persons stratified by age (< 60 years, ≥ 60 years), specific chronic diseases (e.g. diabetes, chronic diseases, cancer), and region (Berlin/Brandenburg vs. other federal states of Germany). Standardized questionnaires were administered by a market research institute through online, telephone, or face-to-face methods. We assessed sepsis knowledge through a series of questions and the ability to recognize sepsis as an emergency through five case vignettes. To identify predictors of sepsis knowledge and the ability to recognize sepsis as a medical emergency, we conducted multiple linear regressions. RESULTS Of the 36 items on sepsis knowledge, participants answered less than 50 per cent correctly (mean 44.1%; standard deviation (SD) 20.1). Most patients knew that sepsis is a defensive host response to infection (75.9%), but only 30.8% knew that vaccination can prevent infections that lead to sepsis. Across the five vignettes, participants identified sepsis as an emergency in only 1.33 of all cases on average (SD = 1.27). Sepsis knowledge was higher among participants who were older, female, and more highly educated and who reported more extensive health information seeking behaviour. The ability to recognize sepsis as an emergency was higher among younger participants, participants without chronic diseases, and participants with higher health literacy, but it was not significantly associated with sepsis knowledge. CONCLUSIONS Risk groups showed low levels of knowledge regarding the preventive importance of vaccination and a low ability to recognize sepsis as a medical emergency. Higher levels of sepsis knowledge alone were not sufficient to improve the ability to identify sepsis as a medical emergency. It is crucial to develop effective educational strategies-especially for persons with lower education levels and infrequent health information seeking behaviour-that not only transfer but also facilitate the choice of appropriate actions, such as seeking timely emergency care. TRIAL REGISTRATION DRKS00024561. Registered 9 March 2021.
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Affiliation(s)
- Sebastian Born
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Stoystraße 3, 07743, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Wiltrud Abels
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sepsis Foundation, Berlin, Germany
| | - Silke Piedmont
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Emergency Medicine Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sepsis Foundation, Berlin, Germany
| | - Evjenia Toubekis
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Odette Wegwarth
- Heisenberg Chair for Medical Risk Literacy and Evidence-Based Decisions, Clinic for Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Daniel Schwarzkopf
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Alnofaiey Y, Alharthi SM, Alhulayfi RM, Alqurashi MM, Alsufyani RM, Alamri GM. Public Awareness and Knowledge of Sepsis: A Cross-Sectional Survey of Adults in the Western Region of Saudi Arabia. Cureus 2023; 15:e49102. [PMID: 38125215 PMCID: PMC10731998 DOI: 10.7759/cureus.49102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sepsis is a condition in which the body responds improperly to harmful microorganisms and infections, which triggers a chain reaction throughout the body. It is a life-threatening medical emergency. Infections that lead to sepsis, in most cases, start in the lungs, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis rapidly leads to multi-organ failure and death. The risk factors for sepsis include a weakened immune system, being 65 years of age or older, and chronic medical conditions including diabetes, lung disease, and kidney disease. A thorough understanding of the warning signs and symptoms, as well as prompt medical attention, are required for successful sepsis management. Early detection, antimicrobial therapy, and intensive supportive care are the cornerstones of the best sepsis management. AIM This study aimed to assess the public awareness and knowledge of sepsis in the Western region of Saudi Arabia. METHODS This was a cross-sectional study conducted from the beginning of June till the end of August 2023, among 425 Saudi adults in the Western region above the age of 18 years. Data collection was carried out by administering a questionnaire through an online platform. The questionnaire included demographic information, risk factors, symptoms, protective factors, and the source of information about sepsis. The data collected were reviewed, coded, and then fed into IBM SPSS Statistics software for Windows, Version 21 (released 2012; IBM Corp., Armonk, NY). RESULTS The study found that almost half (47.8%) of participants were aware of bacterial septicemia, with the most common sources of awareness being the internet (48.3%) and healthcare professionals (47.8%). Low immunity (75.9%) and infection (39.4%) have been the most frequently reported risk factors. Fever (31.5%) was the most commonly reported symptom. Participants from Yanbu and Jeddah and those in the healthcare sector had significantly higher awareness levels. The majority of participants (93.1%) had poor knowledge about the risk factors and symptoms of septicemia, with only 3.4% having fair or good knowledge. Sociodemographic characteristics did not significantly affect knowledge about septicemia (P>0.05). CONCLUSION In summary, this study reveals that while awareness of bacterial septicemia is relatively high among the sample population, knowledge about the risk factors and symptoms of the condition is low. The internet, healthcare professionals, and social media play significant roles in raising awareness about bacterial septicemia. Participants from Yanbu and Jeddah, students, and healthcare sector workers had higher awareness levels compared to other groups. However, overall knowledge levels regarding bacterial septicemia were poor across various demographic characteristics. This highlights the need for targeted educational interventions to improve knowledge and understanding of septicemia and its risk factors and symptoms among the general population. Further research is needed to identify the reasons for low knowledge levels and develop effective strategies to improve awareness about bacterial septicemia.
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Affiliation(s)
- Yasser Alnofaiey
- Internal Medicine, College of Medicine, Taif University, Taif, SAU
| | | | | | | | | | - Ghadi M Alamri
- Medicine, College of Medicine, Taif University, Taif, SAU
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van der Slikke EC, Beumeler LFE, Holmqvist M, Linder A, Mankowski RT, Bouma HR. Understanding Post-Sepsis Syndrome: How Can Clinicians Help? Infect Drug Resist 2023; 16:6493-6511. [PMID: 37795206 PMCID: PMC10546999 DOI: 10.2147/idr.s390947] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
Sepsis is a global health challenge, with over 49 million cases annually. Recent medical advancements have increased in-hospital survival rates to approximately 80%, but the escalating incidence of sepsis, owing to an ageing population, rise in chronic diseases, and antibiotic resistance, have also increased the number of sepsis survivors. Subsequently, there is a growing prevalence of "post-sepsis syndrome" (PSS). This syndrome includes long-term physical, medical, cognitive, and psychological issues after recovering from sepsis. PSS puts survivors at risk for hospital readmission and is associated with a reduction in health- and life span, both at short and long term, after hospital discharge. Comprehensive understanding of PSS symptoms and causative factors is vital for developing optimal care for sepsis survivors, a task of prime importance for clinicians. This review aims to elucidate our current knowledge of PSS and its relevance in enhancing post-sepsis care provided by clinicians.
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Affiliation(s)
- Elisabeth C van der Slikke
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
| | - Lise F E Beumeler
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, 8934AD, the Netherlands
- Department of Sustainable Health, Campus Fryslân, University of Groningen, Groningen, 8911 CE, the Netherlands
| | - Madlene Holmqvist
- Department of Infection Medicine, Skåne University Hospital Lund, Lund, 221 84, Sweden
| | - Adam Linder
- Department of Infection Medicine, Skåne University Hospital Lund, Lund, 221 84, Sweden
| | - Robert T Mankowski
- Department of Physiology and Aging, University of Florida, Gainesville, FL, 32610, USA
| | - Hjalmar R Bouma
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9713GZ, the Netherlands
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Coccolini F, Sartelli M, Sawyer R, Rasa K, Viaggi B, Abu-Zidan F, Soreide K, Hardcastle T, Gupta D, Bendinelli C, Ceresoli M, Shelat VG, Broek RT, Baiocchi GL, Moore EE, Sall I, Podda M, Bonavina L, Kryvoruchko IA, Stahel P, Inaba K, Montravers P, Sakakushev B, Sganga G, Ballestracci P, Malbrain MLNG, Vincent JL, Pikoulis M, Beka SG, Doklestic K, Chiarugi M, Falcone M, Bignami E, Reva V, Demetrashvili Z, Di Saverio S, Tolonen M, Navsaria P, Bala M, Balogh Z, Litvin A, Hecker A, Wani I, Fette A, De Simone B, Ivatury R, Picetti E, Khokha V, Tan E, Ball C, Tascini C, Cui Y, Coimbra R, Kelly M, Martino C, Agnoletti V, Boermeester MA, De'Angelis N, Chirica M, Biffl WL, Ansaloni L, Kluger Y, Catena F, Kirkpatrick AW. Source control in emergency general surgery: WSES, GAIS, SIS-E, SIS-A guidelines. World J Emerg Surg 2023; 18:41. [PMID: 37480129 PMCID: PMC10362628 DOI: 10.1186/s13017-023-00509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/30/2023] [Indexed: 07/23/2023] Open
Abstract
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
| | | | - Robert Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | | | - Bruno Viaggi
- ICU Dept., Careggi University Hospital, Florence, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, University of Bergen, Bergen, Norway
| | - Timothy Hardcastle
- Dept. of Health - KwaZulu-Natal, Surgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Deepak Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital, Newcastle, Australia
| | - Marco Ceresoli
- General Surgery Dept., Monza University Hospital, Monza, Italy
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Njmegen, The Netherlands
| | | | | | - Ibrahima Sall
- Département de Chirurgie, Hôpital Principal de Dakar, Hôpital d'Instruction des Armées, Dakar, Senegal
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Philip Stahel
- Department of Surgery, East Carolina University, Brody School of Medicine, Greenville, NC, USA
| | - Kenji Inaba
- LAC+USC Medical Center, Los Angeles, CA, USA
| | - Philippe Montravers
- Département d'Anesthésie-Réanimation CHU Bichat Claude Bernard, Paris, France
| | - Boris Sakakushev
- Research Institute of Medical, University Plovdiv/University Hospital St. George, Plovdiv, Bulgaria
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Ballestracci
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | - Manu L N G Malbrain
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | | | - Manos Pikoulis
- General Surgery, Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Krstina Doklestic
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | - Marco Falcone
- Infectious Disease Dept., Pisa University Hospital, Pisa, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Viktor Reva
- Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russia
| | | | - Salomone Di Saverio
- General Surgery Dept, San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | - Matti Tolonen
- Emergency Surgery, Meilahti Tower Hospital, Helsinki, Finland
| | - Pradeep Navsaria
- Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Zsolt Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | | | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | | | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Edward Tan
- Emergency Department, Radboud University Medical Center, Njmegen, The Netherlands
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Carlo Tascini
- Infectious Disease Dept., Udine University Hospital, Udine, Italy
| | - Yunfeng Cui
- Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | | | | | | | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Mircea Chirica
- Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Walt L Biffl
- Trauma and Emergency Surgery, Scripss Memorial Hospital, La Jolla, CA, USA
| | - Luca Ansaloni
- General Surgery, Pavia University Hospital, Pavia, Italy
| | - Yoram Kluger
- General Surgery, Rambam Medical Centre, Haifa, Israel
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept, Bufalini Hospital, Cesena, Italy
| | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
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Regina J, Le Pogam MA, Niemi T, Akrour R, Pepe S, Lehn I, Wasserfallen JB, Calandra T, Meylan S. Sepsis awareness and knowledge amongst nurses, physicians and paramedics of a tertiary care center in Switzerland: A survey-based cross-sectional study. PLoS One 2023; 18:e0285151. [PMID: 37379303 DOI: 10.1371/journal.pone.0285151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Sepsis is a leading cause of morbidity and mortality. Prompt recognition and management are critical to improve outcomes. METHODS We conducted a survey among nurses and physicians of all adult departments of the Lausanne University Hospital (LUH) and paramedics transporting patients to our hospital. Measured outcomes included professionals' demographics (age, profession, seniority, unit of activity), quantification of prior sepsis education, self-evaluation, and knowledge of sepsis epidemiology, definition, recognition, and management. Correlation between surveyed personnel and sepsis perceptions and knowledge were assessed with univariable and multivariable logistic regression models. RESULTS Between January and October 2020, we contacted 1'216 of the 4'417 professionals (27.5%) of the LUH, of whom 1'116 (91.8%) completed the survey, including 619 of 2'463 (25.1%) nurses, 348 of 1'664 (20.9%) physicians and 149 of 290 (51.4%) paramedics. While 98.5% of the participants were familiar with the word "sepsis" (97.4% of nurses, 100% of physicians and 99.3% of paramedics), only 13% of them (physicians: 28.4%, nurses: 5.9%, paramedics: 6.8%) correctly identified the Sepsis-3 consensus definition. Similarly, only 48% and 49.3% of the physicians and 10.1% an 11.9% of the nurses knew that SOFA was a sepsis defining score and that the qSOFA score was a predictor of increased mortality, respectively. Furthermore, 15.8% of the physicians and 1.0% of the nurses knew the three components of the qSOFA score. For patients with suspected sepsis, 96.1%, 91.6% and 75.8% of physicians respectively chose blood cultures, broad-spectrum antibiotics and fluid resuscitation as therapeutic interventions to be initiated within 1 (76.4%) to 3 (18.2%) hours. For nurses and physicians, recent training correlated with knowledge of SOFA score (ORs [95%CI]: 3.956 [2.018-7.752] and 2.617 [1.527-4.485]) and qSOFA (ORs [95%CI]: 5.804 [2.653-9.742] and 2.291 [1.342-3.910]) scores purposes. Furthermore, recent training also correlated with adequate sepsis definition (ORs [95%CI]: 1.839 [1.026-3.295]) and the components of qSOFA (ORs [95%CI]: 2.388 [1.110-5.136]) in physicians. CONCLUSIONS This sepsis survey conducted among physicians, nurses and paramedics of a tertiary Swiss medical center identified a deficit of sepsis awareness and knowledge reflecting a lack of sepsis-specific continuing education requiring immediate corrective measures.
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Affiliation(s)
- Jean Regina
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marie-Annick Le Pogam
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Tapio Niemi
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Rachid Akrour
- Service of Geriatrics and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Santino Pepe
- Medical Directorate, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Lehn
- Director of Nursing, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Thierry Calandra
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Medicine and Department of Laboratory Medicine and Pathology, Service of Immunology and Allergy, Center for Human Immunology Lausanne, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, University of Paris Cité, Paris, France
| | - Sylvain Meylan
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Ruffin F, Van Horn E, Letvak S, Kennedy‐Malone L. Exploration of pre‐hospital patient delays in seeking care for symptoms of bacteremia and sepsis: A qualitative study. Nurs Open 2022; 10:2934-2945. [PMID: 36480356 PMCID: PMC10077354 DOI: 10.1002/nop2.1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/07/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022] Open
Abstract
AIM We explored patient pre-hospital delays in seeking care for symptoms of bacteremia and sepsis. DESIGN A qualitative descriptive study. METHODS In January 2021, we recruited a convenience sample of four men and six women who were former patients diagnosed with bacteremia. We conducted semi-structured interviews by telephone. The tape-recorded interviews were transcribed, coded and analysed using the Common-Sense Model of Self-Regulation. Data analysis continued until May 2021. RESULTS The three main themes included: gathering threads of information, weaving together the threads of information and impact and outcome of the illness. The main finding revealed was that an inability to recognize symptoms of bacteremia resulted in delayed help-seeking. Participants had difficulty recognizing their symptoms as being related to bacteremia when they lacked experience with infection or could not differentiate them from symptoms of other chronic co-morbid conditions. Recognizing symptoms and searching for their meaning was an early step in developing an action plan for seeking care. Patient-reported physical and psychological outcomes of the infection on their quality of life (QOL) varied widely, from none to major impact.
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Affiliation(s)
- Felicia Ruffin
- Department of Medicine Duke University Medical Center Durham North Carolina USA
- School of Nursing University of North Carolina at Greensboro Durham North Carolina USA
| | - Elizabeth Van Horn
- School of Nursing University of North Carolina at Greensboro Durham North Carolina USA
| | - Susan Letvak
- School of Nursing University of North Carolina at Greensboro Durham North Carolina USA
| | - Laurie Kennedy‐Malone
- School of Nursing University of North Carolina at Greensboro Durham North Carolina USA
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Knowledge, Practice and Attitudes to the Management of Sepsis in Jamaica. J Crit Care Med (Targu Mures) 2022; 8:232-241. [DOI: 10.2478/jccm-2022-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/10/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sepsis is a life-threatening dysfunction resulting from the dysregulated host response to infection. The mortality of sepsis in Jamaica remains high amid the proven efficacy of the Surviving Sepsis Guidelines implementation in some countries.
Aim of study
To evaluate the inter-relationship of healthcare workers’ attitude towards, knowledge of and practice of sepsis management in Jamaica.
Material and methods
A survey was done using an anonymous self-administered validated questionnaire to healthcare workers across Jamaica. Questions on knowledge, attitude, and practice of sepsis within private and public hospitals were answered.
Results
A total of 616 healthcare workers were eligible for analysis. Most respondents agree that healthcare workers need more training on sepsis (93.7%) and that formal sepsis training modules should be implemented at their hospitals or practice (93.2%). Several signs of sepsis as outlined by qSOFA were correctly identified as such by most respondents (60.6% to 76.4%), with the exception of a low PaCO2 (34.9%), which was correctly identified by a minority of respondents. While a majority (69.3%) were able to correctly define sepsis, only 8.8% of respondents knew the annual sepsis mortality rate. Postgraduate training (p<0.01) and formal sepsis training (p<0.05) were both predictive of high correct knowledge and practice scores. Specialization in Anaesthesia/ Critical Care Medicine (p<0.05) or Emergency Medicine (p<0.05) was predictive of high knowledge scores and Internal Medicine predictive of high practice scores (p<0.01).
Conclusions
This study revealed that education for healthcare workers on sepsis and the implementation of SSC is needed in Jamaica.
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9
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Parsons Leigh J, Brundin-Mather R, Moss SJ, Nickel A, Parolini A, Walsh D, Bigham BL, Carter AJE, Fox-Robichaud A, Fiest KM. Public awareness and knowledge of sepsis: a cross-sectional survey of adults in Canada. Crit Care 2022; 26:337. [PMID: 36329489 PMCID: PMC9632573 DOI: 10.1186/s13054-022-04215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Sepsis is a life-threatening complication of the body’s response to infection. The financial, medical, and psychological costs of sepsis to individuals and to the healthcare system are high. Most sepsis cases originate in the community, making public awareness of sepsis essential to early diagnosis and treatment. There has been no comprehensive examination of adult’s sepsis knowledge in Canada. Methods We administered an online structured survey to English- or French-literate adults in Canada. The questionnaire comprised 28 questions in three domains: awareness, knowledge, and information access. Sampling was stratified by age, sex, and geography and weighted to 2016 census data. We used descriptive statistics to summarize responses; demographic differences were tested using the Rao–Scott correction for weighted chi-squared tests and associations using multiple variable regression. Results Sixty-one percent of 3200 adults sampled had heard of sepsis. Awareness differed by respondent’s residential region, sex, education, and ethnic group (p < 0.001, all). The odds of having heard of sepsis were higher for females, older adults, respondents with some or completed college/university education, and respondents who self-identified as Black, White, or of mixed ethnicity (p < 0.01, all). Respondent’s knowledge of sepsis definitions, symptoms, risk factors, and prevention measures was generally low (53.0%, 31.5%, 16.5%, and 36.3%, respectively). Only 25% of respondents recognized vaccination as a preventive strategy. The strongest predictors of sepsis knowledge were previous exposure to sepsis, healthcare employment, female sex, and a college/university education (p < 0.001, all). Respondents most frequently reported hearing about sepsis through television (27.7%) and preferred to learn about sepsis from healthcare providers (53.1%). Conclusions Sepsis can quickly cause life-altering physical and psychological effects and 39% of adults sampled in Canada have not heard of it. Critically, a minority (32%) knew about signs, risk factors, and strategies to lower risk. Education initiatives should focus messaging on infection prevention, employ broad media strategies, and use primary healthcare providers to disseminate evidence-based information. Future work could explore whether efforts to raise public awareness of sepsis might be bolstered or hindered by current discourse around COVID-19, particularly those centered on vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04215-6.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada. .,Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
| | | | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Angie Nickel
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ariana Parolini
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Deirdre Walsh
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Blair L Bigham
- Division of Critical Care, Department of Anesthesia, Stanford University, Stanford, CA, USA
| | - Alix J E Carter
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.,Emergency Health Services Nova Scotia, Halifax, NS, Canada
| | - Alison Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
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10
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Brinkworth JF, Shaw JG. On race, human variation, and who gets and dies of sepsis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9544695 DOI: 10.1002/ajpa.24527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica F. Brinkworth
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
- Department of Evolution, Ecology and Behavior University of Illinois Urbana‐Champaign Urbana Illinois USA
| | - J. Grace Shaw
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
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11
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Text-Based vs. Graphical Information Formats in Sepsis Prevention and Early Detection: A Randomized Controlled Trial on Informed Choice. J Clin Med 2022; 11:jcm11133659. [PMID: 35806943 PMCID: PMC9267388 DOI: 10.3390/jcm11133659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Sepsis is associated with 11 million global deaths annually. Although serious consequences of sepsis can generally be avoided with prevention and early detection, research has not yet addressed the efficacy of evidence-based health information formats for different risk groups. This study examines whether two evidence-based health information formats—text based and graphical—differ in how well they foster informed choice and risk and health literacy and in how well they support different sepsis risk groups. Based on a systematic literature review, two one-page educative formats on sepsis prevention and early detection were designed—one text based and one graphical. A sample of 500 German participants was randomly shown one of the two formats; they were then assessed on whether they made informed choices and on their risk and health literacy. For both formats, >70% of participants made informed choices for sepsis prevention and >75% for early detection. Compared with the graphical format, the text-based format was associated with higher degrees of informed choice (p = 0.012, OR = 1.818) and risk and health literacy (p = 0.032, OR = 1.710). Both formats can foster informed choices and risk and health literacy on sepsis prevention and early detection, but the text-based format appears to be more effective.
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12
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Recognising Sepsis as a Health Priority in Sub-Saharan African Country: Learning Lessons from Engagement with Gabon’s Health Policy Stakeholders. Healthcare (Basel) 2022; 10:healthcare10050877. [PMID: 35628014 PMCID: PMC9141529 DOI: 10.3390/healthcare10050877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022] Open
Abstract
Sepsis has been recognised as a global health priority by the United Nations World Health Assembly, which adopted a resolution in 2017 to improve sepsis prevention, diagnosis, and management globally. This study investigated how sepsis is prioritised in Gabon. From May to November 2021, we conducted a qualitative study in healthcare stakeholders at the local, regional, and national levels. Stakeholders included the Ministry of Health (MOH), ethics/regulatory bodies, research institutions, academic institutions, referral hospitals, international funders, and the media. Twenty-three multisectoral stakeholders were interviewed. Respondents indicated that sepsis is not yet prioritised in Gabon due to the lack of evidence of its burden. They also suggest that the researchers should focus on linkages between sepsis and the countries’ existing health sector priorities to accelerate sepsis prioritisation in health policy. Stakeholder awareness and engagement might be accelerated by involving the media in the generation of communication strategies around sepsis awareness and prioritisation. There is a need for local, regional and national evidence to be generated by researchers and taken up by policymakers, focusing on linkages between sepsis and a country’s existing health sector priorities. The MOH should set sepsis reporting structures and develop appropriate sepsis guidelines for identification, management, and prevention.
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13
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Patient, Public, and Healthcare Professional's Sepsis Awareness, Knowledge, and Information Seeking Behaviors: A Scoping Review. Crit Care Med 2022; 50:1187-1197. [PMID: 35481953 PMCID: PMC9275848 DOI: 10.1097/ccm.0000000000005564] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sepsis awareness and understanding are important aspects of prevention, recognition, and clinical management of sepsis. We conducted a scoping review to identify and map the literature related to sepsis awareness, general knowledge, and information-seeking behaviors with a goal to inform future sepsis research and knowledge translation campaigns.
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14
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Souza DC, Barreira ER, Shieh HH, Ventura AMC, Bousso A, Troster EJ. Prevalence and outcomes of sepsis in children admitted to public and private hospitals in Latin America: a multicenter observational study. Rev Bras Ter Intensiva 2021; 33:231-242. [PMID: 34231803 PMCID: PMC8275081 DOI: 10.5935/0103-507x.20210030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To report the prevalence and outcomes of sepsis in children admitted to public and private hospitals. METHODS Post hoc analysis of the Latin American Pediatric Sepsis Study (LAPSES) data, a cohort study that analyzed the prevalence and outcomes of sepsis in critically ill children with sepsis on admission at 21 pediatric intensive care units in five Latin American countries. RESULTS Of the 464 sepsis patients, 369 (79.5%) were admitted to public hospitals and 95 (20.5%) to private hospitals. Compared to those admitted to private hospitals, sepsis patients admitted to public hospitals did not differ in age, sex, immunization status, hospital length of stay or type of admission but had higher rates of septic shock, higher Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality 2 (PIM 2), and Pediatric Logistic Organ Dysfunction (PELOD) scores, and higher rates of underlying diseases and maternal illiteracy. The proportion of patients admitted from pediatric wards and sepsis-related mortality were higher in public hospitals. Multivariate analysis did not show any correlation between mortality and the type of hospital, but mortality was associated with greater severity on pediatric intensive care unit admission in patients from public hospitals. CONCLUSION In this sample of critically ill children from five countries in Latin America, the prevalence of septic shock within the first 24 hours at admission and sepsis-related mortality were higher in public hospitals than in private hospitals. Higher sepsis-related mortality in children admitted to public pediatric intensive care units was associated with greater severity on pediatric intensive care unit admission but not with the type of hospital. New studies will be necessary to elucidate the causes of the higher prevalence and mortality of pediatric sepsis in public hospitals.
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Affiliation(s)
- Daniela Carla Souza
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Pediátrica, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Eliane Roseli Barreira
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil.,Departamento de Emergência, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
| | - Huei Hsin Shieh
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Albert Bousso
- Departamento de Pediatria, Escola Médica, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil.,Hospital Municipal Vila Santa Catarina - São Paulo (SP), Brasil
| | - Eduardo Juan Troster
- Departamento de Medicina, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Pediátrica, Hospital Israelita Albert Einstein - São Paulo (SP), Brasil
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15
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Adegbite BR, Edoa JR, Rylance J, Jacob ST, Kawale P, Adegnika AA, Grobusch MP. Knowledge of health workers relating to sepsis awareness and management in Lambaréné, Gabon. Acta Trop 2021; 219:105914. [PMID: 33831345 DOI: 10.1016/j.actatropica.2021.105914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/29/2022]
Abstract
Background In 2016, the third international consensus definitions for sepsis and septic shock (Sepsis-3) task force provided revised definitions for sepsis and septic shock. This study explores knowledge regarding sepsis among health workers in Lambaréné, Gabon. Methods We conducted a self-administered questionnaire-based survey about sepsis among health workers from the referral regional hospital, the research center, and primary care health facilities in the Lambaréné region. Participants were from the referral regional hospital, the research center, and primary health care facilities. A score of one was given to each correct answer. The global score out of a possible score of twenty was calculated, and the proportion of correct responses was determined. Results A total of 115 health workers (physicians, nurses and assistant nurses) completed the questionnaire, of which 48.7% (56/115) provided a valid definition of sepsis, but 74% (85/115) had never heard about the quick Sequential Organ Failure Assessment (qSOFA) score. The proportion of correct answers was comparable across the three health profession categories. The median global score across all health workers was 11 [IQR, 9-14.5] out of 20. Physicians attained higher global scores [14 (IQR, 11-15)] than assistant nurses [11 (IQR, 8-13), P=0.007]; their global score was comparable to that of nurses. Conclusion There are considerable knowledge gaps regarding sepsis among health workers in Lambaréné, potentially impairing the prompt recognition and management of sepsis. There is a need to establish periodic up-to-date training to improve sepsis knowledge.
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16
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The Presentation, Pace, and Profile of Infection and Sepsis Patients Hospitalized Through the Emergency Department: An Exploratory Analysis. Crit Care Explor 2021; 3:e0344. [PMID: 33655214 PMCID: PMC7909460 DOI: 10.1097/cce.0000000000000344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
To characterize the signs and symptoms of sepsis, compare them with those from simple infection and other emergent conditions and evaluate their association with hospital outcomes. Design Setting Participants and INTERVENTION A multicenter, retrospective cohort study of 408,377 patients hospitalized through the emergency department from 2012 to 2017 with sepsis, suspected infection, heart failure, or stroke. Infected patients were identified based on Sepsis-3 criteria, whereas noninfected patients were identified through diagnosis codes. MEASUREMENTS AND MAIN RESULTS Signs and symptoms were identified within physician clinical documentation in the first 24 hours of hospitalization using natural language processing. The time of sign and symptom onset prior to presentation was quantified, and sign and symptom prevalence was assessed. Using multivariable logistic regression, the association of each sign and symptom with four outcomes was evaluated: sepsis versus suspected infection diagnosis, hospital mortality, ICU admission, and time of first antibiotics (> 3 vs ≤ 3 hr from presentation). A total of 10,825 signs and symptoms were identified in 6,148,348 clinical documentation fragments. The most common symptoms overall were as follows: dyspnea (35.2%), weakness (27.2%), altered mental status (24.3%), pain (23.9%), cough (19.7%), edema (17.8%), nausea (16.9%), hypertension (15.6%), fever (13.9%), and chest pain (12.1%). Compared with predominant signs and symptoms in heart failure and stroke, those present in infection were heterogeneous. Signs and symptoms indicative of neurologic dysfunction, significant respiratory conditions, and hypotension were strongly associated with sepsis diagnosis, hospital mortality, and intensive care. Fever, present in only a minority of patients, was associated with improved mortality (odds ratio, 0.67, 95% CI, 0.64-0.70; p < 0.001). For common symptoms, the peak time of symptom onset before sepsis was 2 days, except for altered mental status, which peaked at 1 day prior to presentation. Conclusions The clinical presentation of sepsis was heterogeneous and occurred with rapid onset prior to hospital presentation. These findings have important implications for improving public education, clinical treatment, and quality measures of sepsis care.
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17
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Guarino M, Gambuti E, Alfano F, De Giorgi A, Maietti E, Strada A, Ursini F, Volpato S, Caio G, Contini C, De Giorgio R. Predicting in-hospital mortality for sepsis: a comparison between qSOFA and modified qSOFA in a 2-year single-centre retrospective analysis. Eur J Clin Microbiol Infect Dis 2020; 40:825-831. [PMID: 33118057 PMCID: PMC7979592 DOI: 10.1007/s10096-020-04086-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022]
Abstract
Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. This study proposed a new tool, i.e. modified qSOFA, for the early prognostic assessment of septic patients. All cases of sepsis/septic shock consecutively observed in 2 years (January 2017–December 2018), at St. Anna University Hospital of Ferrara, Italy, were included. Each patient was evaluated with qSOFA and a modified qSOFA (MqSOFA), i.e. adding a SpO2/FiO2 ratio to qSOFA. Logistic regression and survival analyses were applied to compare the two scores. A total number of 1137 consecutive cases of sepsis and septic shock were considered. Among them 136 were excluded for incomplete report of vital parameters. A total number of 668 patients (66.7%) were discharged, whereas 333 (33.3%) died because of sepsis-related complications. Data analysis showed that MqSOFA (AUC 0.805, 95% C.I. 0.776–0.833) had a greater ability to detect in-hospital mortality than qSOFA (AUC 0.712, 95% C.I. 0.678–0.746) (p < 0.001). Eighty-five patients (8.5%) were reclassified as high-risk (qSOFA< 2 and MqSOFA≥ 2) resulting in an improvement of sensitivity with a minor reduction in specificity. A significant difference of in-hospital mortality was observed between low-risk and reclassified high-risk (p < 0.001) and low-risk vs. high-risk groups (p < 0.001). We demonstrated that MqSOFA provided a better predictive score than qSOFA regarding patient’s outcome. Since sepsis is an underhanded and time-dependent disease, physicians may rely upon the herein proposed simple score, i.e. MqSOFA, to establish patients’ severity and outcome.
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Affiliation(s)
- Matteo Guarino
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Edoardo Gambuti
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Franco Alfano
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Internal Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Centre of Clinical Epidemiology, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Andrea Strada
- Department of Emergency Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Francesco Ursini
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Stefano Volpato
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Giacomo Caio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Carlo Contini
- Department of Infectious and Dermatology Diseases, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy.
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18
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Schlapbach LJ, Kissoon N, Alhawsawi A, Aljuaid MH, Daniels R, Gorordo-Delsol LA, Machado F, Malik I, Nsutebu EF, Finfer S, Reinhart K. World Sepsis Day: a global agenda to target a leading cause of morbidity and mortality. Am J Physiol Lung Cell Mol Physiol 2020; 319:L518-L522. [PMID: 32812788 DOI: 10.1152/ajplung.00369.2020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Luregn J Schlapbach
- Child Health Research Centre, The University of Queensland and Queensland Children's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care Medicine and Neonatology, and Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Niranjan Kissoon
- Children's and Women's Global Health, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Maha H Aljuaid
- King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ron Daniels
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Imrana Malik
- Department of Critical Care, The University of Texas, Anderson Cancer Center, Houston, Texas
| | - Emmanuel Fru Nsutebu
- Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Konrad Reinhart
- Department of Anesthesia and Surgical Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
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19
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Al-Orainan N, El-Shabasy AM, Al-Shanqiti KA, Al-Harbi RA, Alnashri HR, Rezqallah RA, Mirghani AA. Public Awareness of Sepsis Compared to Acute Myocardial Infarction and Stroke in Jeddah, Saudi Arabia: Questionnaire Study. Interact J Med Res 2020; 9:e16195. [PMID: 32538794 PMCID: PMC7324995 DOI: 10.2196/16195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/11/2019] [Accepted: 01/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sepsis is a state of organ dysfunction caused by an impaired host response to infection. It is one of the leading causes of death globally. Sepsis, acute myocardial infarction (AMI), and stroke share the primary management requirement of rapid intervention. This could be achieved through early presentation to the hospital, which demands previous knowledge of the disease to ensure better outcomes. OBJECTIVE Our study aimed to assess the level of public awareness of sepsis compared with AMI and stroke. METHODS This was a cross-sectional survey study performed in June and July 2018, with 1354 participants from Jeddah, Saudi Arabia, aged ≥18 years. Data entry was performed using Microsoft Excel and statistical analysis including chi-square tests and multilogistic regression was performed using SPSS software. RESULTS A total of 1354 participants were included. Only 56.72% (768/1354) had heard of the term "sepsis" and 48.44% (372/768) of these participants were able to correctly identify it. In addition, 88.33% (1196/1354) had heard the term "myocardial infarction" and 64.63% (773/1196) knew the correct definition of that condition. Stroke was recognized by 81.46% (1103/1354) of participants and 59.20% (653/1103) of these participants correctly identified the condition. The difference between those who had heard of these diseases and those who knew the correct definition significantly differed from the values for awareness of sepsis and its definition. CONCLUSIONS We found that public awareness and knowledge of sepsis are poor amongst the population of Jeddah compared with the awareness and knowledge of AMI and stroke. This lack of knowledge may pose a serious obstruction to the prompt management needed to limit fatal outcomes.
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Affiliation(s)
- Nourah Al-Orainan
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Mohamed El-Shabasy
- Department of Anesthesiology and Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
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20
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Otu A, Nsutebu EF, Hirst JE, Thompson K, Walker K, Yaya S. How to close the maternal and neonatal sepsis gap in sub-Saharan Africa. BMJ Glob Health 2020; 5:e002348. [PMID: 32399259 PMCID: PMC7204918 DOI: 10.1136/bmjgh-2020-002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Akaninyene Otu
- Department of Infection and Travel Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Emmanuel Fru Nsutebu
- Division of Infectious Diseases, Sheikh Shakbout Medical City, Abu Dhabi, United Arab Emirates
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Kelly Thompson
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Walker
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.,The George Institute for Global Health, University of Oxford, Oxford, Oxfordshire, United Kingdom
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21
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Tattoli L, Dell'Erba A, Ferorelli D, Gasbarro A, Solarino B. Sepsis and Nosocomial Infections: The Role of Medico-Legal Experts in Italy. Antibiotics (Basel) 2019; 8:E199. [PMID: 31661804 PMCID: PMC6963620 DOI: 10.3390/antibiotics8040199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/18/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a leading cause of morbidity and mortality worldwide. It is defined as the presence of a Systemic Inflammatory Response Syndrome, and it represents a significant burden for the healthcare system. This is particularly true when it is diagnosed in the setting of nosocomial infections, which are usually a matter of concern with regard to medical liability being correlated with increasing economic costs and people's loss of trust in healthcare. Hence, the Italian governance promotes the clinical risk management with the aim of improving the quality and safety of healthcare services. In this context, the role of medico-legal experts working in a hospital setting is fundamental for performing autopsy to diagnose sepsis and link it with possible nosocomial infections. On the other hand, medico-legal experts are party to the clinical risk management assessment, and deal with malpractice cases and therefore contribute to formulating clinical guidelines and procedures for improving patient safety and healthcare providers' work practices. Due to this scenario, the authors here discuss the role of medico-legal experts in Italy, focusing on sepsis and nosocomial infections.
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Affiliation(s)
- Lucia Tattoli
- S.C. Medicina Legale U - Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Alessandro Dell'Erba
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | - Davide Ferorelli
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
| | | | - Biagio Solarino
- Institute of Legal Medicine Department of Medicine (DIM), School of Medicine, University of Bari A. Moro, 70124 Bari, Italy.
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Jabaley CS, Groff RF, Barnes TJ, Caridi-Scheible ME, Blum JM, O’Reilly-Shah VN. Sepsis information-seeking behaviors via Wikipedia between 2015 and 2018: A mixed methods retrospective observational study. PLoS One 2019; 14:e0221596. [PMID: 31437248 PMCID: PMC6705833 DOI: 10.1371/journal.pone.0221596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/09/2019] [Indexed: 12/29/2022] Open
Abstract
Raising public awareness of sepsis, a potentially life-threatening dysregulated host response to infection, to hasten its recognition has become a major focus of physicians, investigators, and both non-governmental and governmental agencies. While the internet is a common means by which to seek out healthcare information, little is understood about patterns and drivers of these behaviors. We sought to examine traffic to Wikipedia, a popular and publicly available online encyclopedia, to better understand how, when, and why users access information about sepsis. Utilizing pageview traffic data for all available language localizations of the sepsis and septic shock pages between July 1, 2015 and June 30, 2018, significantly outlying daily pageview totals were identified using a seasonal hybrid extreme studentized deviate approach. Consecutive outlying days were aggregated, and a qualitative analysis was undertaken of print and online news media coverage to identify potential correlates. Traffic patterns were further characterized using paired referrer to resource (i.e. clickstream) data, which were available for a temporal subset of the pageviews. Of the 20,557,055 pageviews across 65 linguistic localizations, 47 of the 1,096 total daily pageview counts were identified as upward outliers. After aggregating sequential outlying days, 25 epochs were examined. Qualitative analysis identified at least one major news media correlate for each, which were typically related to high-profile deaths from sepsis and, less commonly, awareness promotion efforts. Clickstream analysis suggests that most sepsis and septic shock Wikipedia pageviews originate from external referrals, namely search engines. Owing to its granular and publicly available traffic data, Wikipedia holds promise as a means by which to better understand global drivers of online sepsis information seeking. Further characterization of user engagement with this information may help to elucidate means by which to optimize the visibility, content, and delivery of awareness promotion efforts.
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Affiliation(s)
- Craig S. Jabaley
- Department of Anesthesiology, Emory University, Atlanta, Georgia, United States of America
- Anesthesiology Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- * E-mail:
| | - Robert F. Groff
- Department of Anesthesiology, Emory University, Atlanta, Georgia, United States of America
- Anesthesiology Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
| | - Theresa J. Barnes
- Department of Anesthesiology, Emory University, Atlanta, Georgia, United States of America
| | | | - James M. Blum
- Department of Anesthesiology, Emory University, Atlanta, Georgia, United States of America
- Anesthesiology Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, United States of America
- Department of Biomedical Informatics, Emory University, Atlanta, Georgia, United States of America
| | - Vikas N. O’Reilly-Shah
- Department of Anesthesiology, University of Washington, Seattle, Washington, United States of America
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23
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Nwankwor OC, McKelvie B, Frizzola M, Hunter K, Kabara HS, Oduwole A, Oguonu T, Kissoon N. A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria. Front Pediatr 2019; 7:234. [PMID: 31245338 PMCID: PMC6579914 DOI: 10.3389/fped.2019.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Infections leading to sepsis are major contributors to mortality and morbidity in children world-wide. Determining the capacity of pediatric hospitals in Nigeria to manage sepsis establishes an important baseline for quality-improvement interventions and resource allocations. Objectives: To assess the availability and functionality of resources and manpower for early detection and prompt management of sepsis in children at tertiary pediatric centers in Nigeria. Methods: This was an online survey of tertiary pediatric hospitals in Nigeria using a modified survey tool designed by the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The survey addressed all aspects of pediatric sepsis identification, management, barriers and readiness. Results: While majority of the hospitals 97% (28/29) reported having adequate triage systems, only 60% (16/27) follow some form of guideline for sepsis management. There was no consensus national guideline for management of pediatric sepsis. Over 50% of the respondents identified deficit in parental education, poor access to healthcare services, failure to diagnose sepsis at referring institutions, lack of medical equipment and lack of a definitive protocol for managing pediatric sepsis, as significant barriers. Conclusions: Certain sepsis-related interventions were reportedly widespread, however, there is no standardized sepsis protocol, and majority of the hospitals do not have pediatric intensive care units (PICU). These findings could guide quality improvement measures at institutional level, and healthcare policy/spending at the national level.
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Affiliation(s)
- Odiraa C Nwankwor
- Division of Critical Care Medicine, Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States.,Division of Critical Care Medicine, Department of Pediatrics, Cooper University Hospital, Camden, NJ, United States
| | - Brianna McKelvie
- Department of Pediatrics, Children's Hospital, Western University, London, ON, Canada
| | - Meg Frizzola
- Division of Critical Care Medicine, Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
| | - Krystal Hunter
- Cooper University Hospital, Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Halima S Kabara
- Department of Anaesthesia/Intensive Care Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abiola Oduwole
- Department of Paediatrics, Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tagbo Oguonu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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24
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Peltan ID, Mitchell KH, Rudd KE, Mann BA, Carlbom DJ, Rea TD, Butler AM, Hough CL, Brown SM. Prehospital Care and Emergency Department Door-to-Antibiotic Time in Sepsis. Ann Am Thorac Soc 2018; 15:1443-1450. [PMID: 30153044 PMCID: PMC6322022 DOI: 10.1513/annalsats.201803-199oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/23/2018] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Early antibiotics improve outcomes for patients with sepsis. Factors influencing antibiotic timing in emergency department (ED) sepsis remain unclear. OBJECTIVES Determine the relationship between prehospital level of care of patients with sepsis and ED door-to-antibiotic time. METHODS This retrospective cohort study comprised patients admitted from the community to an academic ED June 2009 to February 2015 with fluid-refractory sepsis or septic shock. Transfer patients and those whose antibiotics began before ED arrival or after ED discharge were excluded. We used multivariable regression to evaluate the association between the time from ED arrival to antibiotic initiation and prehospital level of care, defined as the highest level of emergency medical services received: none, basic life support (BLS) ambulance, or advanced life support (ALS) ambulance. We measured variation in this association when hypotension was or was not present by ED arrival. RESULTS Among 361 community-dwelling patients with sepsis, the level of prehospital care correlated with illness severity. ALS-treated patients received antibiotics faster than patients who did not receive prehospital care (median, 103 [interquartile range, 75 to 135] vs. 144 [98 to 251] minutes, respectively) or BLS-only patients (168 [100-250] minutes; P < 0.001 for each pairwise comparison with ALS). This pattern persisted after multivariable adjustment, where ALS care (-43 min; 95% confidence interval [CI], -84 to -2; P = 0.033) but not BLS-only care (-4 min; 95% CI, -41 to +34; P = 0.97) was associated with less antibiotic delay compared with no prehospital care. ALS-treated patients more frequently received antibiotics within 3 hours of ED arrival (91%) compared with walk-in patients (62%; adjusted odds ratio, 3.11; 95% CI, 1.20 to 8.03; P = 0.015) or BLS-treated patients (56%; adjusted odds ratio, 4.51; 95% CI, 1.89 to 11.35; P < 0.001). ALS-treated patients started antibiotics faster than walk-in patients in the absence of hypotension by ED arrival (-41 min; 95% CI, -110 to -13; P = 0.009) but not when hypotension was present (+25 min; 95% CI, -43 to +92; P = 0.66). CONCLUSIONS Prehospital ALS but not BLS-only care was associated with faster antibiotic initiation for patients with sepsis without hypotension. Process redesign for non-ALS patients may improve antibiotic timeliness for ED sepsis.
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Affiliation(s)
- Ithan D. Peltan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center and University of Utah School of Medicine, Murray, Utah
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Kristina H. Mitchell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Kristina E. Rudd
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Blake A. Mann
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
- Department of Critical Care Medicine, Virginia Mason Medical Center, Seattle, Washington; and
| | - David J. Carlbom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Thomas D. Rea
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - Catherine L. Hough
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center and University of Utah School of Medicine, Murray, Utah
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25
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Eitze S, Fleischmann-Struzek C, Betsch C, Reinhart K. Determinants of sepsis knowledge: a representative survey of the elderly population in Germany. Crit Care 2018; 22:273. [PMID: 30368239 PMCID: PMC6204268 DOI: 10.1186/s13054-018-2208-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sepsis is a life-threatening medical emergency requiring early diagnosis and urgent treatment. Knowledge is crucial, especially in major risk groups such as the elderly. We therefore assessed sophisticated knowledge about sepsis in the German elderly population. METHODS A telephone survey was carried out with a representative sample of 701 Germans from 16 federal states and a separate cohort of 700 participants from Thuringia, all aged ≥ 60 years. Sepsis knowledge was assessed via a 10-item questionnaire. Sociodemographic data and health information sources were assessed to identify determinants of sepsis knowledge. RESULTS Of the participants, 88.6% had heard the term "sepsis" before; however, 50% of these failed to define sepsis correctly. Even if the knowledge of symptoms was moderately good, most participants could not correctly identify causes of sepsis and underestimated its incidence. Only a minority was aware that immunization may prevent sepsis. Regressions revealed that being younger, better educated and living in rural areas predicted higher levels of sepsis knowledge. Pharmacists were a relevant source of sepsis information. CONCLUSIONS Despite overall awareness of sepsis, the understanding of its risk factors, symptoms and prevention is low in the elderly, with important implications for emergency and intensive care. We suggest further educational measures to improve early sepsis recognition and prevention through vaccination.
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Affiliation(s)
- Sarah Eitze
- Center for Empirical Research in Economics and Behavioral Sciences, Department of Social Media and Communication Sciences, University of Erfurt, Nordhaeuser Strasse 63, 99089 Erfurt, Germany
| | - Carolin Fleischmann-Struzek
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, Department of Social Media and Communication Sciences, University of Erfurt, Nordhaeuser Strasse 63, 99089 Erfurt, Germany
| | - Konrad Reinhart
- Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Huang W, Huang L, Wen M, Fang M, Deng Y, Zeng H. Long non‑coding RNA DILC is involved in sepsis by modulating the signaling pathway of the interleukin‑6/signal transducer and activator of transcription 3/Toll‑like receptor 4 axis. Mol Med Rep 2018; 18:5775-5783. [PMID: 30365067 DOI: 10.3892/mmr.2018.9559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 11/28/2017] [Indexed: 11/05/2022] Open
Abstract
Sepsis is characterized by systemic inflammatory responses. In the present study, the role of deleted in liver cancer 1 (DILC), interleukin (IL)‑6, signal transducer and activator of transcription 3 (STAT3), and Toll‑like receptor 4 (TLR4) in the pathogenesis of sepsis was investigated. Reverse transcription‑quantitative polymerase chain reaction analysis and western blotting were performed to evaluate the effects of lipopolysaccharide (LPS) on the expression of DILC, IL‑6, STAT3, and TLR4, in addition to the effects of DILC and IL‑6 on the synthesis of tumor necrosis factor (TNF‑α), chemokine ligand 5 (CCL5), E‑selectin and C‑X‑C motif chemokine receptor 1 (CXCR1). In addition, the regulatory association between DILC, IL‑6, STAT3 and TLR4 was investigated. LPS reduced the expression level of DILC, and enhanced the expression of IL‑6, STAT3 and TLR4. DILC directly and negatively regulated the synthesis of IL‑6, as demonstrated by the markedly decreased luciferase activity in cells transfected with a wild‑type DILC plasmid. On the other hand, compared with the scramble control, DILC and IL‑6 small interfering (si)RNAs significantly suppressed the expression of IL‑6, STAT3 and TLR4. In addition, DILC siRNA enhanced the expression of IL‑6, STAT3 and TLR4, whereas the expression levels of TNF‑α, CCL5, E‑selectin and CXCR1 in LPS‑treated THP‑1 cells were downregulated following transfection with DILC and IL‑6 siRNAs. In patients with sepsis, DILC expression was inhibited, although the expression levels of IL‑6, STAT3 and TLR4 were upregulated. In addition, the expression levels of TNF‑α, CCL5, E‑selectin and CXCR1 in patients with sepsis were higher compared with normal subjects. Therefore, DILC may mediate the crosstalk between the cascades of IL‑6/STAT3 and TNF‑α signaling, indicating that DILC may act as a prognostic biomarker of sepsis, and may serve as a potential therapeutic target for the treatment of sepsis.
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Affiliation(s)
- Weiping Huang
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Linqiang Huang
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Miaoyun Wen
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Ming Fang
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Yiyu Deng
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Hongke Zeng
- Department of Emergency and Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
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27
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Jabaley CS, Groff RF, Stentz MJ, Moll V, Lynde GC, Blum JM, O'Reilly-Shah VN. Highly visible sepsis publications from 2012 to 2017: Analysis and comparison of altmetrics and bibliometrics. J Crit Care 2018; 48:357-371. [PMID: 30296750 DOI: 10.1016/j.jcrc.2018.09.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE We sought to delineate highly visible publications related to sepsis. Within these subsets, elements of altmetrics performance, including mentions on Twitter, and the correlation between altmetrics and conventional citation counts were ascertained. MATERIALS AND METHODS Three subsets of sepsis publications from 2012 to 2017 were synthesized by the overall Altmetric.com attention score, number of mentions by unique Twitter users, and conventional citation counts. For these subsets, geolocated Twitter activity was plotted on a choropleth, the lag between publication date and altmetrics mentions was characterized, and correlations were examined between altmetrics performance and normalized conventional citation counts. RESULTS Of 57,152 PubMed query results, Altmetric.com data was available for 28,344 (49.6%). The top 50 publications by Altmetric.com attention score and Twitter attention represented a mix of original research and other types of work, garnering attention from Twitter users in 143 countries that was highly contemporaneous with publication. Altmetrics performance and conventional citation counts were poorly correlated. CONCLUSIONS While unreliable to gauge impact or future citation potential, altmetrics may be valuable for parties who wish to detect and drive public awareness of research findings and may enable researchers to dynamically explore the reach of their work in novel dimensions.
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Affiliation(s)
- Craig S Jabaley
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.
| | - Robert F Groff
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA.
| | - Michael J Stentz
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - Vanessa Moll
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - Grant C Lynde
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA.
| | - James M Blum
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, 1670 Clairmont Rd, Decatur, GA 30033, USA; Department of Biomedical Informatics, Emory University School of Medicine, 201 Bowman Dr, Atlanta, GA 30322, USA.
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Department of Anesthesiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329, USA.
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Kim HI, Park S. Sepsis: Early Recognition and Optimized Treatment. Tuberc Respir Dis (Seoul) 2018; 82:6-14. [PMID: 30302954 PMCID: PMC6304323 DOI: 10.4046/trd.2018.0041] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/29/2018] [Accepted: 07/20/2018] [Indexed: 12/12/2022] Open
Abstract
Sepsis is a life-threatening condition caused by infection and represents a substantial global health burden. Recent epidemiological studies showed that sepsis mortality rates have decreased, but that the incidence has continued to increase. Although a mortality benefit from early-goal directed therapy (EGDT) in patients with severe sepsis or septic shock was reported in 2001, three subsequent multicenter randomized studies showed no benefits of EGDT versus usual care. Nonetheless, the early administration of antibiotics and intravenous fluids is considered crucial for the treatment of sepsis. In 2016, new sepsis definitions (Sepsis-3) were issued, in which organ failure was emphasized and use of the terms "systemic inflammatory response syndrome" and "severe sepsis" was discouraged. However, early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis. Also, performance improvement programs have been associated with a significant increase in compliance with the sepsis bundles and a reduction in mortality. To improve sepsis management and reduce its burden, in 2017, the World Health Assembly and World Health Organization adopted a resolution that urged governments and healthcare workers to implement appropriate measures to address sepsis. Sepsis should be considered a medical emergency, and increasing the level of awareness of sepsis is essential.
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Affiliation(s)
- Hwan Il Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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29
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Hantrakun V, Somayaji R, Teparrukkul P, Boonsri C, Rudd K, Day NPJ, West TE, Limmathurotsakul D. Clinical epidemiology and outcomes of community acquired infection and sepsis among hospitalized patients in a resource limited setting in Northeast Thailand: A prospective observational study (Ubon-sepsis). PLoS One 2018; 13:e0204509. [PMID: 30256845 PMCID: PMC6157894 DOI: 10.1371/journal.pone.0204509] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Infection and sepsis are leading causes of death worldwide but the epidemiology and outcomes are not well understood in resource-limited settings. We conducted a four-year prospective observational study from March 2013 to February 2017 to examine the clinical epidemiology and outcomes of adults admitted with community-acquired infection in a resource-limited tertiary-care hospital in Ubon Ratchathani province, Northeast Thailand. Hospitalized patients with infection and accompanying systemic manifestations of infection within 24 hours of admission were enrolled. Subjects were classified as having sepsis if they had a modified sequential organ failure assessment (SOFA) score ≥2 at enrollment. This study was registered with ClinicalTrials.gov, number NCT02217592. A total of 4,989 patients were analyzed. Of the cohort, 2,659 (53%) were male and the median age was 57 years (range 18-101). Of these, 1,173 (24%) patients presented primarily to the study hospital, 3,524 (71%) were transferred from 25 district hospitals or 8 smaller hospitals in the province, and 292 (6%) were transferred from one of 30 hospitals in other provinces. Three thousand seven hundred and sixteen (74%) patients were classified as having sepsis. Patients with sepsis had an older age distribution and a greater prevalence of comorbidities compared to patients without sepsis. Twenty eight-day mortality was 21% (765/3,716) in sepsis and 4% (54/1,273) in non-sepsis patients (p<0.001). After adjusting for gender, age, and comorbidities, sepsis on admission (adjusted hazard ratio [HR] 3.30; 95% confidence interval [CI] 2.48-4.41, p<0.001), blood culture positive for pathogenic organisms (adjusted HR 2.21; 95% CI 1.89-2.58, p<0.001) and transfer from other hospitals (adjusted HR 2.18; 95% CI 1.69-2.81, p<0.001) were independently associated with mortality. In conclusion, mortality of community-acquired sepsis in Northeast Thailand is considerable and transferred patients with infection are at increased risk of death. To reduce mortality of sepsis in this and other resource-limited setting, facilitating rapid detection of sepsis in all levels of healthcare facilities, establishing guidelines for transfer of sepsis patients, and initiating sepsis care prior to and during transfer may be beneficial.
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Affiliation(s)
- Viriya Hantrakun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ranjani Somayaji
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, United States
| | | | | | - Kristina Rudd
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, United States
| | - Nicholas P. J. Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
| | - T. Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, United States
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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30
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Frankling CC, Yeung J, Dark P, Gao F. I spy with my little eye something beginning with S: spotting sepsis. Br J Anaesth 2018; 117:279-81. [PMID: 27543521 DOI: 10.1093/bja/aew254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C C Frankling
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - J Yeung
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - P Dark
- Salford Royal NHS Foundation Trust, Salford, Greater Manchester M6 8HD, UK
| | - F Gao
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
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31
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Increasing influenza and pneumococcal vaccine uptake in the elderly: study protocol for the multi-methods prospective intervention study Vaccination60. BMC Public Health 2018; 18:885. [PMID: 30012141 PMCID: PMC6048840 DOI: 10.1186/s12889-018-5787-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/03/2018] [Indexed: 01/12/2023] Open
Abstract
Background Influenza and pneumococcal vaccination can prevent disease and potentially life-threatening complications like sepsis. Elderly people have an increased risk of severe disease and therefore constitute a major target group for vaccination. To increase vaccination coverage, targeted interventions are needed that take theory-based specific determinants of vaccination behaviour into account. Moreover, message and campaign design should consider specific age-related characteristics (e.g., information processing, media use). The aim of this study is (i) to identify the specific informational and interventional needs of this risk group, (ii) to design and implement a targeted intervention aiming to decrease vaccine hesitancy, increase vaccine uptake and decrease the health and economic burden due to the respective diseases, and (iii) to measure the effect of this evidence-informed intervention on various levels. Methods Prospective, multi-methods intervention study targeting individuals aged ≥60 years in a model region in Germany (federal state of Thuringia, 500,000 inhabitants ≥60 years old). The development of the intervention follows theory-based and evidence-informed principles: Data from a cross-sectional representative study provide insights into specific determinants of the target group’s vaccination behaviour. Additionally, media use is analysed to identify adequate communication channels for specific subgroups. In pilot studies, the intervention materials are adapted to the specific cognitive requirements of the target group. For development and implementation of the intervention, an interdisciplinary and trans-sectoral approach is used, including psychology, communication science, design, medical science, epidemiology and various public health players. The intervention will be implemented in autumn and winter 2017/18 and 2018/19 and adjusted in between. Evaluation of the intervention includes: awareness, use and recall of intervention materials, effects on changes in determinants of vaccination behaviour, self-reported vaccine uptake, and vaccination coverage in the intervention area (primary outcomes), as well as disease incidences (secondary outcomes) and the economic burden of influenza, pneumonia, invasive pneumococcal disease and sepsis for the healthcare system (tertiary outcomes). Discussion The data will add to the body of evidence on the effectiveness of evidence-informed vaccination campaign development as well as on the clinical and economic effects of pneumococcal and influenza vaccination. The effect of the intervention will teach valuable lessons about the principles of campaign development and evaluation, and can motivate a subsequent nationwide intervention. Trial registration DRKS00012653. Registered 24.11.2017. Retrospectively registered.
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Jabaley CS, Blum JM, Groff RF, O'Reilly-Shah VN. Global trends in the awareness of sepsis: insights from search engine data between 2012 and 2017. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:7. [PMID: 29343292 PMCID: PMC5772700 DOI: 10.1186/s13054-017-1914-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/01/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sepsis is an established global health priority with high mortality that can be curtailed through early recognition and intervention; as such, efforts to raise awareness are potentially impactful and increasingly common. We sought to characterize trends in the awareness of sepsis by examining temporal, geographic, and other changes in search engine utilization for sepsis information-seeking online. METHODS Using time series analyses and mixed descriptive methods, we retrospectively analyzed publicly available global usage data reported by Google Trends (Google, Palo Alto, CA, USA) concerning web searches for the topic of sepsis between 24 June 2012 and 24 June 2017. Google Trends reports aggregated and de-identified usage data for its search products, including interest over time, interest by region, and details concerning the popularity of related queries where applicable. Outlying epochs of search activity were identified using autoregressive integrated moving average modeling with transfer functions. We then identified awareness campaigns and news media coverage that correlated with epochs of significantly heightened search activity. RESULTS A second-order autoregressive model with transfer functions was specified following preliminary outlier analysis. Nineteen significant outlying epochs above the modeled baseline were identified in the final analysis that correlated with 14 awareness and news media events. Our model demonstrated that the baseline level of search activity increased in a nonlinear fashion. A recurrent cyclic increase in search volume beginning in 2012 was observed that correlates with World Sepsis Day. Numerous other awareness and media events were correlated with outlying epochs. The average worldwide search volume for sepsis was less than that of influenza, myocardial infarction, and stroke. CONCLUSIONS Analyzing aggregate search engine utilization data has promise as a mechanism to measure the impact of awareness efforts. Heightened information-seeking about sepsis occurs in close proximity to awareness events and relevant news media coverage. Future work should focus on validating this approach in other contexts and comparing its results to traditional methods of awareness campaign evaluation.
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Affiliation(s)
- Craig S Jabaley
- Department of Anesthesiology, Division of Critical Care Medicine , Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA. .,Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.
| | - James M Blum
- Department of Anesthesiology, Division of Critical Care Medicine , Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.,Anesthesiology Service Line, Division of Critical Care Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA.,Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert F Groff
- Department of Anesthesiology, Division of Critical Care Medicine , Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Vikas N O'Reilly-Shah
- Department of Anesthesiology, Division of Critical Care Medicine , Emory University, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.,Department of Anesthesiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
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Nguyen YL, Porcher R, Argaud L, Piquilloud L, Guitton C, Tamion F, Hraiech S, Mira JP. "RéaNet", the Internet utilization among surrogates of critically ill patients with sepsis. PLoS One 2017; 12:e0174292. [PMID: 28358883 PMCID: PMC5373530 DOI: 10.1371/journal.pone.0174292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 03/07/2017] [Indexed: 12/31/2022] Open
Abstract
Context Health-related Internet utilization is common but its use by proxies of critically ill patients is unknown. Our objective was to describe the prevalence and the Internet utilization characteristics among surrogates of critically ill septic patients. We conducted a prospective observational study in French ICUs. Three survey instruments were used to describe ICU organization regarding information delivery, patients and surrogates characteristics. Results 169 surrogates of 146 septic patients hospitalized in 19 ICUs were included. One sixth of ICUs (n = 3, 16%) had their own website. Majority of patients were males (n = 100, 68%), aged 64±1 years old, with a SAPS2 score at 53±17 and required vasopressors (n = 117, 83%), mechanical ventilation (n = 116, 82%). More than one quarter required renal replacement therapy (n = 36, 26%). Majority of surrogates were female, in their fifties. Only one in five knew the word sepsis (n = 27, 16%). Majority of proxies internet users (n = 77; 55%) search on the internet about sepsis. The main motivation was curiosity. Majority of surrogates found the information online reliable, suitable for request and concordant. Prior use of health-related Internet (OR = 20.7 [4.30–100.1]), the presence of a nursing staff during family-physician meetings (OR = 3.33 [1.17–9.53]), a younger patient age (OR = 1.32 [1.01–1.72]) and renal replacement therapy requirement (OR = 2.58 [1.06–6.26]) were associated with health-related Internet use. Neither satisfaction with medical care or information provision, neither presence of anxiety-depression symptoms, were associated with health-related Internet use. Majority of surrogates (N = 76 (52%)) would have like receiving a list of selected websites on sepsis. Conclusions Majority of proxies of critically ill patients with sepsis use Internet to learn more about sepsis. Internet utilization is independent of satisfaction with global ICU care, perceived quality of information delivery by doctors or the existence of anxiety-depression symptoms during ICU stay. The delivery of a list of recommended web sites on sepsis would have been appreciated.
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Affiliation(s)
- Yên-Lan Nguyen
- Medical intensive care unit, Cochin hospital, AP-HP, Paris Descartes University, Paris, France
- Anesthesiology and surgical critical care medicine department, Cochin academic hospital, APHP, Paris Descartes University, Paris, France
- * E-mail:
| | - Raphaël Porcher
- Clinical epidemiology center, INSERM U1153, Hôtel-Dieu academic hospital, APHP, Paris Descartes University, Paris, France
| | - Laurent Argaud
- Medical intensive care unit, Hospices Civils de Lyon, Edouard Herriot academic hospital, Lyon, France
| | - Lise Piquilloud
- Medical intensive care unit, Angers academic hospital, Angers university, Angers, France
| | - Christophe Guitton
- Medical intensive care unit, Nantes academic hospital, Nantes university, Nantes, France
| | - Fabienne Tamion
- Medical intensive care unit, Rouen academic hospital, Rouen university, Rouen, France
| | - Sami Hraiech
- Medical intensive care unit, North hospital Marseille, AP-HM, Marseille, France
| | - Jean-Paul Mira
- Medical intensive care unit, Cochin hospital, AP-HP, Paris Descartes University, Paris, France
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Abstract
BACKGROUND Sepsis, or systemic inflammatory response to infection, is a major childhood disease and a common cause of death in children. Despite its importance, a global perspective on the epidemiology and mortality of pediatric sepsis across the world is still lacking. METHODS A non-systematic review of the medical articles published in Medline from 2005 to 2015. RESULTS Studies suggest that there has been a rise in the number of pediatric sepsis cases along the last two decades, which may relate to the increased survival of preterm and low birth-weight infants and children with severe chronic conditions. Children living in low-income countries represent a vulnerable population for sepsis. Despite several initiatives to improve the diagnosis and early treatment of pediatric sepsis, the mortality resulting from pediatric sepsis remains high, ranging from 5% to 40%. Poor outcomes, however, do not seem to be related to the limitation of resources but to the delay in the recognition and early treatment of sepsis. CONCLUSIONS Educational efforts aiming to increase the awareness on sepsis by the general public and the adherence to the treatment guidelines by healthcare providers may result in significant improvements in sepsis survival. The global attention to pediatric sepsis, however, can only be achieved with the standardization of the definitions and the use of simple and sensitive diagnostic criteria that incorporate the differences in the necessities among different settings and the availability of local resources.
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Affiliation(s)
- Daniela Carla de Souza
- *Pediatric Intensive Care Unit, Hospital Sirio Libanes, São Paulo, Brazil †Pediatric Intensive Care Unit, University Hospital, University of São Paulo, São Paulo, Brazil
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Stoneking L, Denninghoff K, DeLuca L, Keim SM, Munger B. Sepsis Bundles and Compliance With Clinical Guidelines. J Intensive Care Med 2016; 26:172-82. [DOI: 10.1177/0885066610387988] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that prevent adoption of new professional standards. In an attempt to improve patient care and reduce mortality, the Surviving Sepsis Campaign and The Institute for Healthcare Improvement created the resuscitation and management bundles for patients with severe sepsis and septic shock. These bundles have been accepted as best practice by many clinicians since multiple clinical trials have produced similar positive results when they were implemented. However, transferring these research outcomes-based guidelines to the clinical practice arena has been associated with poor compliance due to important barriers to implementation. Delays in the adoption of sepsis bundles are not surprising since the time from validation to implementation of a new clinical practice is typically 17 years. Using sepsis bundles as a model, this article explores why guidelines are important, examines physician adherence to protocols, and reviews the literature on strategies to improve clinical compliance and enhance knowledge translation.
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Affiliation(s)
- Lisa Stoneking
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA,
| | - Kurt Denninghoff
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Lawrence DeLuca
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Samuel M. Keim
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Benson Munger
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA
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Van Scoy LJ, Reading JM, Howrylak JA, Tamhane A, Sherman MS. Low quality of dying and death in patients with septic shock as perceived by nurses and resident physicians. DEATH STUDIES 2016; 40:486-493. [PMID: 27192058 DOI: 10.1080/07481187.2016.1181121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Septic shock is a disease with both high prevalence and mortality. Few studies have evaluated the quality of dying and death (QODD) in patients with septic shock. The authors compared the QODD of patients who died of septic shock versus other causes. They prospectively collected QODD surveys from nurses and residents caring for 196 patients who died in the medical intensive care unit (ICU) at an urban, university hospital. Patients were included in the analysis if either a nurse or resident returned a survey. Chart review established cause of death. The authors compared total QODD scores (on a scale of 0-100) and a single-item score (QODD-1; on a scale of 0-10) of patients who died of septic shock versus other causes. Survey response rates were 59% (n = 155) for residents and 49% (n = 129) for nurses. Nurses rated patients as having lower total QODD and QODD-1 scores for septic (Δ 7.5 points, p = 0.03, and 0.9 points, p = 0.05, respectively). Residents rated septic patients with lower QODD-1 scores than nonseptic patients (Δ 0.8 points, p = 0.03). This study shows that nurses rate patients with septic shock as having lower QODD than patients dying of other causes. These findings are important for clinicians who counsel families of patients dying of septic shock.
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Affiliation(s)
- Lauren Jodi Van Scoy
- a Division of Pulmonary, Critical Care, & Sleep Medicine , Drexel University College of Medicine , Philadelphia , Pennsylvania , USA
| | - Jean M Reading
- a Division of Pulmonary, Critical Care, & Sleep Medicine , Drexel University College of Medicine , Philadelphia , Pennsylvania , USA
| | - Judie A Howrylak
- a Division of Pulmonary, Critical Care, & Sleep Medicine , Drexel University College of Medicine , Philadelphia , Pennsylvania , USA
| | - Apurva Tamhane
- b Department of Medicine , Drexel University College of Medicine , Philadelphia , Pennsylvania , USA
| | - Michael S Sherman
- a Division of Pulmonary, Critical Care, & Sleep Medicine , Drexel University College of Medicine , Philadelphia , Pennsylvania , USA
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Epidemiology of sepsis in ICUs of Western China. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315:801-10. [PMID: 26903338 PMCID: PMC4968574 DOI: 10.1001/jama.2016.0287] [Citation(s) in RCA: 14617] [Impact Index Per Article: 1827.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). KEY FINDINGS FROM EVIDENCE SYNTHESIS Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less. CONCLUSIONS AND RELEVANCE These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.
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Affiliation(s)
- Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Clifford S Deutschman
- Hofstra-Northwell School of Medicine, Feinstein Institute for Medical Research, New Hyde Park, New York
| | - Christopher Warren Seymour
- Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Manu Shankar-Hari
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Djillali Annane
- Department of Critical Care Medicine, University of Versailles, France
| | - Michael Bauer
- Center for Sepsis Control and Care, University Hospital, Jena, Germany
| | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, and Austin Hospital, Melbourne, Victoria, Australia
| | - Gordon R Bernard
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee
| | - Jean-Daniel Chiche
- Réanimation Médicale-Hôpital Cochin, Descartes University, Cochin Institute, Paris, France
| | | | | | - Mitchell M Levy
- Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Greg S Martin
- Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia
| | - Steven M Opal
- Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - Gordon D Rubenfeld
- Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada16Interdepartmental Division of Critical Care, University of Toronto
| | - Tom van der Poll
- Department of Infectious Diseases, Academisch Medisch Centrum, Amsterdam, the Netherlands
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania20Associate Editor, JAMA
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Mellhammar L, Christensson B, Linder A. Public Awareness of Sepsis Is Low in Sweden. Open Forum Infect Dis 2015; 2:ofv161. [PMID: 26634220 PMCID: PMC4664835 DOI: 10.1093/ofid/ofv161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/22/2015] [Indexed: 12/29/2022] Open
Abstract
Background. Sepsis is a serious and common condition with high mortality and morbidity. The public awareness, knowledge, and perception of sepsis in Sweden are unknown. Methods. A survey was performed using an online interview distributed to adults, aged 18–74, between March 6 and 9, 2015. Results. A total of 1001 people responded to the survey. Twenty-one percent of participants had heard of sepsis, whereas more than 86% had heard of each of the other conditions listed; for example, stroke (95%), chronic obstructive pulmonary disease (COPD) (95%), and leukemia (92%). Of those who had heard of sepsis, 93% responded that it is an infection or blood poisoning in an open question. The respondents who had heard of each disease estimated its mortality. For sepsis, the mortality was estimated at an average of 30%, which was at the same level as estimated mortalities for prostate and breast cancer but lower than for stroke, COPD, and leukemia. Conclusions. The awareness and knowledge of sepsis is low. The mortality for sepsis is not as overestimated as for many other diseases. The lack of awareness of sepsis might be a target to improve the outcome for sepsis patients by reducing the prehospital delay and hence enable early interventions. An increased general awareness might also raise interest for funding for research in this area and for its priority in healthcare support.
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Affiliation(s)
- Lisa Mellhammar
- Department of Clinical Sciences, Division of Infection Medicine , Klinikgatan 1, Skåne University Hospital , Lund , Sweden
| | - Bertil Christensson
- Department of Clinical Sciences, Division of Infection Medicine , Klinikgatan 1, Skåne University Hospital , Lund , Sweden
| | - Adam Linder
- Department of Clinical Sciences, Division of Infection Medicine , Klinikgatan 1, Skåne University Hospital , Lund , Sweden
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Reinhart K, Daniels R, Machado FR. The burden of sepsis: a call to action in support of World Sepsis Day 2013. Rev Bras Ter Intensiva 2015; 25:3-5. [PMID: 23887752 PMCID: PMC4031861 DOI: 10.1590/s0103-507x2013000100002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine Erlanger Allee 10107747 Jena, Germany.
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Abstract
OBJECTIVES To explore and describe the subjective experiences and long-term impact of severe sepsis on survivors of severe sepsis and their informal caregivers (e.g., spouse or family member) through qualitative research methods. DESIGN A qualitative exploratory study using semi-structured interviews with survivors of severe sepsis and their informal caregivers in the United Kingdom and United States. Participants also completed a demographic background form and sites provided medical history details. Transcripts were analyzed using a thematic analysis approach. SETTING Patients were recruited from a large National Health Service hospital in the United Kingdom and a level 1 trauma center hospital in the United States. Caregivers were recruited through eligible patients. Interviews were conducted either face to face in participant's homes or another convenient location or over the telephone. PATIENTS Patients who were 18 years old or older and had experienced an episode of severe sepsis in the previous 12 months were recruited by clinical staff in each hospital. Caregivers were family members or friends who had provided informal care for the patient after their episode of severe sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Thirty-nine interviews were conducted with 22 patients and 17 informal caregivers (of these 28 were conducted face-to-face and 11 by telephone). Five main themes were identified in the qualitative analysis: awareness and knowledge of severe sepsis; experience of hospitalization, ongoing impact of severe sepsis; impact on caregivers; and support after severe sepsis. Experiences varied depending on the patients' health prior to the severe sepsis, with the worst affected reporting lasting impacts on multiple aspects of their life. CONCLUSIONS The study extends what was understood about severe sepsis from the patients' and caregivers' perspectives from the previous limited literature. Caregivers as well as patients reported enduring impact. The study also identified problems of lack of awareness of diagnosis and understanding of severe sepsis by patients and caregivers and difficulties accessing appropriate healthcare providers and ancillary services after discharge from hospital.
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Shime N. A Survey of the Competency of Ambulance Service Personnel in the Diagnosis and Management of Sepsis. J Emerg Med 2015; 49:147-51. [PMID: 25802163 DOI: 10.1016/j.jemermed.2014.12.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/30/2014] [Accepted: 12/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Few studies have evaluated the current status of knowledge of sepsis in ambulance service personnel. OBJECTIVE Our aim was to ascertain the levels of competency and proficiency of ambulance service personnel in the diagnosis and management of severe sepsis. METHODS A questionnaire was submitted to a sample of 208 participants in a professional ambulance service conference, and was recovered on site. The study probed eight areas of sepsis diagnosis and management based on modifications of a questionnaire used in a previous study. RESULTS The term sepsis in Japanese, Haiketsushou, was familiar to 99% of Japanese certified emergency life-saving technicians (ELST) (Group I) and to 92% of noncertified ambulance service personnel (Group II), although 15% of participants in Group I and 44% in Group II ignored the meaning of sepsis. The definition of sepsis as "body's response to infection," "blood poisoning," or "shock due to bacteria in blood" were selected by 17%, 16%, and 37%, respectively, in Group I, and 4%, 6%, and 22%, respectively, in Group II. The mortality associated with sepsis was underestimated by 57% in Group I and 78% in Group II. Vital signs raising a suspicion for sepsis and their pertinent ranges were correctly chosen by only 50% of certified ELST. Hypothermia was prominently undervalued as a sign raising the suspicion of sepsis. CONCLUSIONS Insufficient knowledge and perception for sepsis in Japanese ambulance services is revealed. A higher level of onsite or formal postgraduate education needs to be provided with a view to improve the prehospital management of sepsis.
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Affiliation(s)
- Nobuaki Shime
- Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Bhagwanjee S, Ugarte S. Sepsis in vulnerable populations. Glob Heart 2014; 9:281-8. [PMID: 25667179 DOI: 10.1016/j.gheart.2014.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 12/29/2022] Open
Abstract
Despite the acquisition of a large body of evidence, there are many unanswered questions about sepsis. The definition of this disease is plagued by the lack of a simple pathophysiological description linking cause to effect and the activation of host immune responses that hinders disease progression at the same time producing multiorgan dysfunction. A plethora of inconsistent clinical features has served to obfuscate rather than illuminate. The Surviving Sepsis Guidelines (SSG) are a major advance because it comprehensively interrogates all aspects of care for the critically ill. For vulnerable populations living in low- and middle-income countries, this guideline is ineffectual because of the lack of region-specific data, differences in etiology of sepsis and burden of disease, limited human capacity and infrastructure, as well as socioeconomic realities. Appropriate care must be guided by common sense guidelines that are sensitive to local realities and adapted as relevant data are acquired.
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Affiliation(s)
- Satish Bhagwanjee
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
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Park M, Kim K, Lee JH, Kang C, Jo YH, Kim DH, Kang KW, Lee SH, Park C, Kim J, Chung H, Park H, Jang S. Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke. Clin Exp Emerg Med 2014; 1:41-48. [PMID: 27752551 PMCID: PMC5052826 DOI: 10.15441/ceem.14.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/29/2022] Open
Abstract
Objective Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis. Methods Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years. Results A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke. Conclusion There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock.
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Affiliation(s)
- Minji Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyeong Won Kang
- Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Chanjong Park
- Department of Emergency Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heajin Chung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunmi Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Prehospital intravenous access and fluid resuscitation in severe sepsis: an observational cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:533. [PMID: 25260233 PMCID: PMC4212132 DOI: 10.1186/s13054-014-0533-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/04/2014] [Indexed: 01/20/2023]
Abstract
Introduction Prompt treatment of severe sepsis in the Emergency Department reduces deaths, but the role of prehospital fluid resuscitation is unknown. We sought to determine the risk-adjusted association between prehospital fluid administration and hospital mortality among emergency medical services (EMS) patients admitted with severe sepsis. Methods We performed a prospective, observational study of patients hospitalized with severe sepsis on admission among 45,394 adult EMS encounters taken to 15 hospitals from 11/2009 to 12/2010 by a two-tier EMS system in King County, Washington. The region mandated recording of prehospital intravenous catheter and fluid administration in prehospital records, along with detailed demographic, incident, physiologic, and hospital adjustment variables. We determined the effect of prehospital intravenous catheter or fluid versus no catheter or fluid on all-cause mortality using multivariable logistic regression. Results Of all encounters, 1,350 met criteria for severe sepsis on admission, of whom 205 (15%) died by hospital discharge, 312 (23%) received prehospital intravenous fluid, 90 (7%) received a prehospital catheter alone and 948 (70%) did not receive catheter or fluid. EMS administered a median prehospital fluid volume of 500 mL (interquartile range (IQR): 200, 1000 mL). In adjusted models, the administration of any prehospital fluid was associated with reduced hospital mortality (Odds ratio =0.46; 95% Confidence interval: 0.23, 0.88; P =0.02) compared to no prehospital fluid. The odds of hospital mortality were also lower among severe sepsis patients treated with prehospital intravenous catheter alone (Odds ratio =0.3; 95% Confidence interval: 0.17 to 0.57; P <0.01). Conclusions In a population-based study, the administration of prehospital fluid and placement of intravenous access were associated with decreased odds of hospital mortality compared with no prehospital catheter or fluid. Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0533-x) contains supplementary material, which is available to authorized users.
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Mujika M, Zuzuarregui A, Sánchez-Gómez S, de Tejada GM, Arana S, Pérez-Lorenzo E. Screening and selection of synthetic peptides for a novel and optimized endotoxin detection method. J Biotechnol 2014; 186:162-8. [DOI: 10.1016/j.jbiotec.2014.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 11/29/2022]
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Do physicians have lower risk of severe sepsis and associated mortality? A matched cohort study*. Crit Care Med 2014; 42:816-23. [PMID: 24231761 DOI: 10.1097/ccm.0000000000000033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Physicians generally have higher disease awareness and easier access to medical care, which may help them reduce risk of developing severe sepsis and associated mortality when they suffer from acute infection. However, the opposite situation may occur due to the presence of potential barriers to healthcare in physicians. We aim to examine the risk of severe sepsis and associated mortality in physicians. DESIGN A matched cohort study. SETTING Registry of medical professionals and inpatient and outpatient claims data from Taiwan's National Health Insurance Research Database. SUBJECTS Physicians (n = 29,697) in Taiwan and a group of persons who were demographically and socioeconomically matched (1:1 ratio) and without any medical education and background. All subjects were followed from the index date (January 1, 2000) to the occurrence of endpoint, withdrawal, or December 31, 2008, whichever date came first. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was development of severe sepsis. Secondary outcome was 90-day mortality following severe sepsis. The overall incidence density of severe sepsis was lower in physicians than in controls (3.25 vs 3.90 per 1,000 person-years, p < 0.001). According to the Cox regression model, severe sepsis develops in physicians 24% less likely than controls after baseline covariates were adjusted (adjusted hazard ratio, 0.76; 95% CI, 0.68-0.85). The 90-day mortality rates were similar between physicians and controls with severe sepsis (46.5% vs 45.7%, p = 0.72). However, after controlling for the baseline and additional covariates, the risk of death was significantly lower in physicians than in controls (adjusted hazard ratio, 0.82; 95% CI, 0.71-0.95). CONCLUSIONS These findings support the hypothesis that physicians are less likely than controls to develop or die of severe sepsis, implying that medical knowledge, higher disease awareness, and easier healthcare access in physicians may help reduce their risk of severe sepsis and associated mortality.
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Romay E, Ferrer R. Future options for (economically) sustainable research in sepsis. Blood Purif 2014; 37 Suppl 1:18-21. [PMID: 24457491 DOI: 10.1159/000356833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The relentless increase in healthcare costs and the global economic crisis require us to rethink the way research is done. The heterogeneity of patients is a major challenge in designing and coordinating high-quality studies about sepsis. Studies on new treatments and devices, such as polymyxin B hemoperfusion, must be optimized not only for potential benefits for a specific population (i.e. efficacy), but also for their eventual implementation in real-world situations (i.e. effectiveness) and for economic costs (i.e. efficiency). In this regard, theragnosis and newer statistical tools could help us obtain useful information from real-life observational data. In this review, we discuss the basic components required for sustainable research in polymyxin B hemoperfusion.
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Affiliation(s)
- Eduardo Romay
- Intensive Care Department, Mutua Terrassa University Hospital, Terrassa, Spain
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Abstract
The worldwide burden of sepsis is high and is increasing. Therefore, this ailment needs a strong lobby, independent of interests generated by pharmaceutical companies. Current evidence-based knowledge must be applied worldwide to reduce the high mortality rate of sepsis. The Global Sepsis Alliance (GSA) was inaugurated in September of 2010 and now represents more than 600,000 health care professionals from more than 70 countries. The GSA was founded to focus on programs to better understand that sepsis is an emergency and to foster a greater understanding of the medical burden of sepsis among the public, with policy makers, philanthropists, and health care professionals. All concerned groups and societies are encouraged to learn from each other and to join forces in the fight against sepsis at a global level. More information is available on the GSA Web site at www.globalsepsisalliance.com.
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