title: A "three delays" model for severe sepsis in resource-limited countries.
abstract: OBJECTIVE
  The developing world carries the greatest burden of sepsis-related mortality, but success in managing severe sepsis in resource-limited countries (RLCs) remains challenging. A "three delays" model has been developed to describe factors influencing perinatal mortality in developing nations. This model has been validated across different World Health Organization regions and has provided the framework for policymakers to plan targeted interventions. Here, we propose a three delays model for severe sepsis in RLCs.
  
  
  METHODS
  A literature review was performed using the PubMed, Google Scholar, and Ovid databases. Additional sources were found after review of the reference lists from retrieved articles.
  
  
  RESULTS
  We propose a three delays model for severe sepsis in adults in RLCs. The model highlights limitations in the 3 basic pillars of sepsis management: (1) sepsis recognition and diagnosis at the time of triage, (2) initial focused resuscitation, and (3) postresuscitation clinical monitoring and reassessment.
  
  
  CONCLUSIONS
  Characterizing the major barriers to effective treatment of severe sepsis in RLCs frames the problem in a language common to global health circles, which may stimulate further research, streamline treatment, and reduce sepsis-related mortality in the developing world.
authors.affiliation: Division of Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. Electronic address: apapali@umm.edu.
authors.forename: Alfred
authors.initials: A
authors.lastname: Papali
authors.affiliation: Division of Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Michael T
authors.initials: MT
authors.lastname: McCurdy
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Emilie J B
authors.initials: EJ
authors.lastname: Calvello
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003422:Critical Care; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003906:Developing Countries; D005440:Fluid Therapy / Q000379:methods; D017048:Health Care Costs; D057220:Health Literacy; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D008962:Models, Theoretical; D010102:Oxygen Inhalation Therapy / Q000379:methods; D012151:Resuscitation / Q000706:statistics & numerical data; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014218:Triage
chemical_list: D000900:Anti-Bacterial Agents
keywords: Critical care; Developing country; Global health; Intensive care; Resource-limited; Sepsis