title: Epidemiology and outcomes in patients with severe sepsis admitted to the hospital wards.
abstract: OBJECTIVE
  The purpose of this study was to detail the trajectory and outcomes of patients with severe sepsis admitted from the emergency department to a non-intensive care unit (ICU) setting and identify risk factors associated with adverse outcomes.
  
  
  METHODS
  This was a single-center retrospective cohort study conducted at a tertiary, academic hospital in the United States between 2005 and 2009. The primary outcome was a composite outcome of ICU transfer within 48 hours of admission and/or 28-day mortality.
  
  
  RESULTS
  Of 1853 patients admitted with severe sepsis, 841 (45%) were admitted to a non-ICU setting, the rate increased over time (P < .001), and 12.5% of these patients were transferred to the ICU within 48 hours and/or died within 28 days. In multivariable models, age (P < .001), an oncology diagnosis (P < .001), and illness severity as measured by Acute Physiologic and Chronic Health Evaluation II (P = .04) and high (≥4 mmol/L) initial serum lactate levels (P = .005) were associated with the primary outcome.
  
  
  CONCLUSIONS
  Patients presenting to the emergency department with severe sepsis were frequently admitted to a non-ICU setting, and the rate increased over time. Of 8 patients admitted to the hospital ward, one was transferred to the ICU within 48 hours and/or died within 28 days of admission. Factors present at admission were identified that were associated with adverse outcomes.
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Stacey-Ann
authors.initials: SA
authors.lastname: Whittaker
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
authors.affiliation: Department of Emergency Medicine, Medstar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC.
authors.forename: Munish
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Nuala J
authors.initials: NJ
authors.lastname: Meyer
authors.affiliation: University of Pennsylvania Health System, Philadelphia, PA.
authors.forename: Craig
authors.initials: C
authors.lastname: Kean
authors.affiliation: The Wharton School, University of Pennsylvania, Philadelphia, PA.
authors.forename: Dylan S
authors.initials: DS
authors.lastname: Small
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: mark.mikkelsen@uphs.upenn.edu.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
mesh_terms: D018806:APACHE; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality*; D014481:United States
keywords: ICU transfer; Infection; Mortality; Outcomes; Severe sepsis