title: Characteristics, treatment and outcomes for all emergency department patients fulfilling criteria for septic shock: a prospective observational study.
abstract: OBJECTIVE
  Most published data on emergency department (ED) patients with septic shock have been generated from studies examining the effect of early protocolised resuscitation in selected cohorts. Consequently, these data do not generally represent patients falling outside trial inclusion criteria or judged unsuitable for aggressive treatment. Our aim was to determine the characteristics, treatment and outcomes for all ED patients fulfilling the criteria for septic shock.
  
  
  METHODS
  Septic shock patients were identified from a prospective database of consecutive ED patients admitted with infection. Descriptive data were compared with those from previous studies and associations between ED processes of care and mortality were determined.
  
  
  RESULTS
  A total of 399 septic shock patients were identified, with a 30-day mortality of 19.5%. The median ED length of stay was 9.2 h. Rates of vasopressor use (22.6%) and ICU admission (37.3%) were low. Subgroups fulfilling the lactate criteria alone, hypotension criteria alone and both criteria represented distinct shock phenotypes with increasing severity of illness and mortality. Mortality for patients with limitations to treatment determined in the ED was 65.6% and 6.1% for those without limitations. Greater volumes of intravenous fluid and early vasopressor therapy for appropriate patients were associated with survival.
  
  
  CONCLUSIONS
  Median length of stay over 9 hours may have enhanced identification of patients with limitations to treatment and fluid responders, reducing invasive therapies and ICU admissions. Distinct shock phenotypes were apparent, with implications for revision of septic shock definitions and future trial design. Liberal fluids and early vasopressor use in appropriate patients were associated with survival.
authors.affiliation: Departments of Emergency Medicine.|School of Medicine, University of Queensland.
authors.forename: Julian M
authors.initials: JM
authors.lastname: Williams
authors.affiliation: Departments of Emergency Medicine.|School of Medicine, University of Queensland.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: University of Queensland-Ochsner Clinical School, Herston, Queensland, Australia.
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Dymond
authors.affiliation: Departments of Emergency Medicine.|School of Medicine, University of Queensland.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chu
authors.affiliation: Departments of Emergency Medicine.|School of Medicine, University of Queensland.
authors.forename: Anthony F T
authors.initials: AFT
authors.lastname: Brown
authors.affiliation: Intensive Care, Royal Brisbane and Women's Hospital.|School of Medicine, University of Queensland.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*