National estimates of severe sepsis in United States emergency departments.
OBJECTIVE
The emergency department (ED) often serves as the first site for the recognition and treatment of patients with suspected severe sepsis. However, few evaluations of the national epidemiology and distribution of severe sepsis in the ED exist. We sought to determine national estimates of the number, timing, ED length of stay, and case distribution of patients presenting to the ED with suspected severe sepsis.


METHODS
Analysis of 2001-2004 ED data from the National Hospital Ambulatory Medical Care Survey.


METHODS
National multistage probability sample of United States ED data.


METHODS
Adult (age, >or=18 yrs) patients with suspected severe sepsis, defined as the concurrent presence of an infec-tion (ED International Classification of Diseases, 9th Revision; ICD-9) diagnosis of infection, or a triage temperature <96.8 degrees F or >or=100.4 degrees F) and organ dysfunction (ED ICD-9) diagnosis of organ dysfunction, intubation, or a triage systolic blood pressure <or=90 mm Hg).


METHODS
None.


METHODS
Estimated number of ED patients presenting with suspected severe sepsis, and their times of arrival, ED lengths of stay, and clinical characteristics.


RESULTS
Of 331.5 million adult ED visits, approximately 2.3 million (571,000 annually, 0.69%; 95% confidence interval [CI], 0.61-0.77%) were for suspected severe sepsis. Mean ED length of stay for suspected severe sepsis was 4.7 hrs (95% CI, 4.3-5.1 hrs), with 20.4% spending >6 hrs in the ED. Of suspected severe sepsis patients, 20.6% presented to a low-volume ED (<or=20,000 annual visits), 15.6% presented to ED in non-Metropolitan Statistical Areas, and 53.5% presented to EDs without medical school affiliations. More than half arrived by ambulance.


CONCLUSIONS
Suspected severe sepsis patients account for more than 500,000 ED visits annually, with individual patients spending an average of almost 5 hrs in the ED. These national data offer key systemwide information for designing and implementing strategies for severe sepsis treatment.
Wang
Henry E
HE
Departments of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. wanghe@upmc.edu
Shapiro
Nathan I
NI
Angus
Derek C
DC
Yealy
Donald M
DM
D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014481:United States / Q000453:epidemiology