title: Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study.
abstract: Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3-4 for non-sepsis and 4 IQR 3-6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36-85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.
authors.affiliation: Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.|ACT Directorate, Cwm Taf University Health Board, Llantrisant, United Kingdom.
authors.forename: Tamas
authors.identifier: http://orcid.org/0000-0003-3632-8844
authors.initials: T
authors.lastname: Szakmany
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lundin
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Sharif
authors.affiliation: Critical Care Directorate, Cardiff and Vale University Health Board, Cardiff, United Kingdom.
authors.forename: Gemma
authors.initials: G
authors.lastname: Ellis
authors.affiliation: Critical Care Directorate, Cardiff and Vale University Health Board, Cardiff, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Morgan
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Maja
authors.initials: M
authors.lastname: Kopczynska
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Amrit
authors.initials: A
authors.lastname: Dhadda
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Mann
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Danielle
authors.initials: D
authors.lastname: Donoghue
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: Rollason
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Brownlow
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Francesca
authors.initials: F
authors.lastname: Hill
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Grace
authors.initials: G
authors.lastname: Carr
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Turley
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Hassall
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Llywela
authors.initials: L
authors.lastname: Davies
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Atkinson
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Molly
authors.initials: M
authors.lastname: Jones
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Nerys
authors.initials: N
authors.lastname: Jones
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Rhodri
authors.initials: R
authors.lastname: Martin
authors.affiliation: Cardiff University Research Society (CUReS), Cardiff University School of Medicine, Cardiff, United Kingdom.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Ibrahim
authors.affiliation: Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Hall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010362:Patients' Rooms / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D014852:Wales / Q000453:epidemiology