title: Can the characteristics of emergency department attendances predict poor hospital outcomes in patients with sepsis?
abstract: BACKGROUND
  The emergency department (ED) is often the initial site of identification of patients with sepsis. We aimed to determine the characteristics of ED attendances that predict poor hospital outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study of adult patients in eight metropolitan EDs in Perth, Western Australia, from 2001 to 2006. Patients diagnosed with sepsis in the ED were identified using the International Classification of Diseases, 10th Revision-Australian Modification code in the Emergency Department Information System (EDIS) database. The EDIS database was subsequently linked to mortality and hospital morbidity records. The following characteristics were examined: triage category, mode of arrival, source of referral and hospital of presentation. Multivariate logistic regression was performed to identify predictors of hospital mortality, prolonged length of stay, and admission to the intensive care unit (ICU).
  
  
  RESULTS
  In the 1,311 patients diagnosed with sepsis in the ED, the hospital mortality and ICU admission rates were 19.5% and 18.5%, respectively. The mean hospital length of stay was 12 ± 15 days. Acute triage categories predicted both hospital mortality and ICU admissions, while mode of arrival by ambulance was a predictor of all poor hospital outcomes (p < 0.001). Patients who presented to non-teaching hospitals had similar hospital outcomes as patients who presented to teaching hospitals. The source of referrals was not a predictor of poor hospital outcomes (p > 0.05).
  
  
  CONCLUSIONS
  Mode of arrival and triage score, which are characteristics unique to the ED, may predict poor hospital outcomes in patients with sepsis.
authors.affiliation: Emergency Department, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. irwani_ibrahim@nuhs.edu.sg.
authors.forename: Irwani
authors.initials: I
authors.lastname: Ibrahim
authors.forename: Ian G
authors.initials: IG
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015331:Cohort Studies; D016001:Confidence Intervals; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*; D014904:Western Australia