Emergency Medicine

More than half a million patients visit the emergency department for severe sepsis each year

About 750,000 individuals in the United States each year develop severe sepsis, a blood infection that can lead to organ failure and even death (in 30 percent of cases). More than two-thirds (over 571,000) of this group end up in the emergency department (ED), according to a new study. More than half of these patients arrive at the ED by ambulance, and they spend an average of nearly 5 hours in the ED (compared with 3.4 hours for other ED visits). These findings underscore the community-acquired rather than hospital-acquired nature of severe sepsis, notes Henry E. Wang, M.D., M.S., of the University of Pittsburgh School of Medicine. Dr. Wang and fellow researchers analyzed ED data from the 2001-2004 National Hospital Ambulatory Care Survey.

The researchers defined patients with severe sepsis as those with fever, hypothermia, hypotension (systolic blood pressure of 90 mm Hg or less), respiratory failure or intubation, and other factors. About 40 percent of the patients had both fever and hypotension. High-volume EDs (more than 60,000 visits per year) cared for disproportionately larger numbers of patients with suspected severe sepsis than low-volume (20,000 or fewer visits per year) EDs.

While most of these patients arrived at the ED during daylight hours, 26 percent arrived during "off hours" (8 pm to 6 am). More than half of these patients were elderly; 17 percent resided at nursing homes, and most were white. These national data should help inform design and implementation strategies for severe sepsis treatment.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13628).

See "National estimates of severe sepsis in United States emergency departments," by Dr. Wang, Nathan I. Shapiro, M.D., M.P.H., Derek C. Angus, M.D., M.P.H., and Donald M. Yealy, M.D., in the August 2007 Critical Care Medicine 35(8), pp. 1928-1936.

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