title: Outcome of delayed resuscitation bundle achievement in emergency department patients with septic shock.
abstract: The aim of this study was to assess whether delayed resuscitation bundle compliance from 6 to 12 h after a diagnosis of septic shock has an impact upon 28-day mortality. A prospective observational study on consecutive adult patients with septic shock was performed in the Emergency Department (ED) of a tertiary care university-affiliated hospital between January 2010 and July 2012. Compliance with the resuscitation bundle was assessed at 6 and 12 h after a septic shock diagnosis (time 0). Patients were divided into three groups: early compliance (≤6 h), delayed compliance (>6 but ≤12 h), and non-compliance (>12 h). The 28-day mortality was compared among the groups. A total of 332 patients were included, with an overall 28-day mortality of 17.2%. The mean age was 63.9 years; 57.8% were men. Early compliance was achieved in 195 patients (58.7%), delayed compliance in 59 patients (19.8%), and non-compliance in 78 patients (23.5%). The groups did not differ in baseline sequential organ failure assessment illness severity. However, the non-compliance group had a significantly higher mortality (29.5%) than the delayed-compliance (13.6%) and early-compliance (13.3%) groups (p = 0.04). Delayed compliance was associated with a lower mortality risk than non-compliance (adjusted odds ratio 0.32, 95% confidence interval: 0.13-0.82, p = 0.02). In conclusion, if bundle therapy be started at the time of presentation, the outcome of delayed resuscitation bundle compliance within 12 h is same as that of early resuscitation bundle compliance within 6 h, and these are better than that of the patients who had late or no compliance.
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86, Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Sohn
authors.forename: Seung Mok
authors.initials: SM
authors.lastname: Ryoo
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Seo
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Bum Jin
authors.initials: BJ
authors.lastname: Oh
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D012772:Shock, Septic / Q000628:therapy*; D016896:Treatment Outcome