title: Severe sepsis in the emergency department - an observational cohort study from the university hospital of the West Indies.
abstract: OBJECTIVE
  To describe the incidence, treatment and outcomes of patients with severe sepsis and septic shock in a setting where early goal directed therapy (EGDT) is not routinely performed.
  
  
  METHODS
  An observational study of all adult patients admitted from the emergency department (ED) of the University Hospital of the West Indies (UHWI) with a diagnosis of severe sepsis and septic shock from July 5, 2007 to September 1, 2008 was conducted. Baseline parameters, treatment patterns and in-hospital outcomes were evaluated.
  
  
  RESULTS
  A total of 58 011 patients were seen and 762 (1.3%) had sepsis, 117 (15.4%) of whom were classified as severe sepsis or septic shock. Mean (SD) age was 59.2 (23.3) years and 49% were female. Medical history included hypertension (29%), diabetes mellitus (26%), stroke (8%), heart failure (6%) and HIV (6%). The most common sources of sepsis were pneumonia (67%) and urinary tract infection (46%). Median, interquartile range (IQR) time from triage to antibiotic administration was 126 (88, 220) minutes and antibiotics were given to 65.7% within three hours. Overall, organisms were sensitive to empirical antibiotics in 69%. Median (IQR) lactate was 5.3 (4.5, 7.5) mmol/L. Most patients (95%) were admitted to the ward; 1% went to the intensive care unit (ICU) and 2% died in the ED. Mean (SD) length of hospital stay was 9.5 (10.3) days. In-hospital mortality was 25% and survival correlated inversely with age (rpb = -0.25; p = 0.006).
  
  
  CONCLUSIONS
  Despite a lack of EGDT, sepsis treatment patterns were consistent with "best-practice" and mortality was lower than international comparators.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica. romayne.edwards@digicel.blackberry.com
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: R
authors.initials: R
authors.lastname: Hutson
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Departmnent of Emergency Medicine, Wayne State University School of Medicine, Michigan, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sherwin
authors.affiliation: Health Research Resource Unit, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: G
authors.initials: G
authors.lastname: Gordon-Strachan
authors.affiliation: Health Research Resource Unit, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica.
authors.forename: M
authors.initials: M
authors.lastname: Frankson
authors.affiliation: Departmnent of Emergency Medicine, Wayne State University School of Medicine, Michigan, USA.
authors.forename: P
authors.initials: P
authors.lastname: Levy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007563:Jamaica / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000150:complications / Q000188:drug therapy; D011446:Prospective Studies; D011787:Quality of Health Care; D018805:Sepsis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents