title: ICU Admission Source as a Predictor of Mortality for Patients With Sepsis.
abstract: OBJECTIVE
  Sepsis is the leading noncardiac cause of intensive care unit (ICU) death. Pre-ICU admission site may be associated with mortality of ICU patients with sepsis. This study quantifies mortality differences among patients with sepsis admitted to an ICU from a hospital ward, emergency department (ED), or an operating room (OR).
  
  
  METHODS
  We conducted a retrospective cohort study of 1762 adults with sepsis using ICU record data obtained from a clinical database of an academic medical center. Survival analysis provided crude and adjusted hazard rate ratio (HRR) estimates comparing hospital mortality among patients from hospital wards, EDs, and ORs, adjusted for age, sex, and severity of illness.
  
  
  RESULTS
  Mortality of patients with sepsis differed based on the pre-ICU admission site. Compared to patients admitted from an ED, patients admitted from hospital wards had higher mortality (HRR: 1.35; 95% confidence interval [CI]: 1.09-1.68) and those admitted from an OR had lower mortality (HRR: 0.37; 95% CI: 0.23-0.58).
  
  
  CONCLUSIONS
  Patients with sepsis admitted to an ICU from a hospital ward experienced greater mortality than patients with sepsis admitted to an ICU from an ED. These findings indicate that there may be systematic differences in the selection of patient care locations, recognition, and management of patients with sepsis that warrant further investigation.
authors.affiliation: 1 Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Motzkus
authors.affiliation: 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Stavroula A
authors.initials: SA
authors.lastname: Chrysanthopoulou
authors.affiliation: 3 Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Luckmann
authors.affiliation: 4 UMASS Memorial Health Care, Worcester, MA, USA.
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Rincon
authors.affiliation: 1 Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA.|2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.affiliation: 1 Clinical and Population Health Research Program, University of Massachusetts Medical School, Worcester, MA, USA.|5 Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.|6 Departments of Anesthesiology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Lilly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D006748:Hospital Departments; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009873:Operating Rooms; D010360:Patient Transfer; D011182:Postoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D055815:Young Adult
keywords: emergency department; intensive care unit; sepsis