• Medicina clinica · Apr 2019

    Comparative Study

    Activation of a code sepsis in the emergency department is associated with a decrease in mortality.

    • Neus Robert Boter, Josep Maria Mòdol Deltell, Irma Casas Garcia, Gemma Rocamora Blanch, Gemma Lladós Beltran, and Anna Carreres Molas.
    • Servicio de Urgencias, Hospital Universitario Germans Trias i Pujol, Badalona, España; Universidad Autónoma de Barcelona, Bellaterra, Barcelona, España. Electronic address: neusrobert1982@gmail.com.
    • Med Clin (Barc). 2019 Apr 5; 152 (7): 255-260.

    ObjectivesTo evaluate the impact of a code sepsis (CS) activation, complying with recommendations, the evolution of patients with severe sepsis in the emergency room and determine independent factors associated to mortality.MethodAll patients attending the emergency room with severe sepsis during a 6-month period were included. Complying with Surviving Sepsis Campaign recommendations, patients' average stay, intensive care admissions and 30-day mortality were assessed. Two groups were compared: CS activation (A) and no activation (NA).ResultsA total of 114 episodes were found, 61.4% belonging to group A and 38.6% to NA. Patients in group A presented hypotension more frequently (61.5% vs 34.4%; P=.005). Patients in group NA more frequently had lactate levels of >3mmol/L (48.3% vs 80%; P=.01), and abdominal focus of sepsis (34.3% vs 13%; P=.01). In group A, blood cultures were more frequently drawn in the first hour (95% vs 41.7%; P<.001), early antibiotic was administered (76.9% vs 25%; p=.005) and fluid replacement carried out (54.5% vs 18.2%; P=.01). Global achievement of CS objectives was higher in group A (31.4% vs 9.1%; P=.006). In group NA more patients were admitted to the intensive care unit (10% vs 36.4%; P<.001), had longer average stays (10.2 days SD 6.9 vs 14.4 days SD 5.8; P<.001) and a higher mortality rate (4.3% vs 34.1%; P<.001). CRP>200mg/l (OR 33.7; P<.001) and the no activation of CS (OR 13.3; p=.001) resulted in being independent factors associated with mortality.ConclusionsThe implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

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