title: Delays From First Medical Contact to Antibiotic Administration for Sepsis.
abstract: OBJECTIVE
  To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012.
  
  
  METHODS
  All emergency medical services encounters with community acquired sepsis transported to the hospital.
  
  
  RESULTS
  Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7-8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40-0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1-7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00-1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61).
  
  
  CONCLUSIONS
  Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 2Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 3Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 4Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seymour
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Christian
authors.initials: C
authors.lastname: Martin-Gill
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.forename: Damon
authors.initials: D
authors.lastname: Scales
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017714:Community-Acquired Infections; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality*; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents