• Arman Ameripour, Elizabeth Herrera, Olivia Coskey, Justin Ng, Cesar Cornejo Ochoa, Allison Modesette, Jenny T Lee, Truman Ray K G C Chun, Jasmeet Kaur, Andrew W Hertel, Barry C Smith, and Brian L Delmonaco.
• College of Osteopathic Medicine of the Pacific - Northwest, United States of America.
• Am J Emerg Med. 2025 Jan 9; 90: 616461-64.

IntroductionWe investigated the extent to which demographic characteristics, clinical care aspects, and relevant biomarkers predicted sepsis-related mortality among patients transferred from a rural, low-volume emergency department (ED) to an urban, high-volume, level-2 trauma center.MethodsWe conducted an observational study among adult severe sepsis patients (N = 242) who, within a community-based regional healthcare system, presented to one of the four rural, low-volume EDs and were subsequently transferred to the urban, high-volume, level-2 trauma center, and were identified as septic at either location. We evaluated in-hospital and 30 days after discharge mortality.ResultsIn-hospital mortality rate was predicted by previous admission to an ICU (OR 5.02, 95 % CI: 1.89-15.94, p = 0.002), identification of sepsis prior to transfer (OR 0.29, 95 % CI: 0.11-0.74, p = 0.01), and a moderately abnormal lactate level (OR 0.22, 95 % CI: 0.05-0.79, p = 0.03). Mortality 30 days after discharge was predicted by previous admission to an ICU (OR: 3.28, 95 % CI: 1.62-6.97, p = 0.001), abnormal red cell distribution width (OR: 2.23, 95 % CI: 1.11-4.60, p = 0.03), identification of sepsis prior to transfer (OR: 0.26, 95 % CI: 0.12-0.54, p < 0.001), and a moderately abnormal lactate (OR: 0.32, 95 % CI: 0.12-0.79, p = 0.02).DiscussionEarly identification of sepsis, as well as attention to prior ICU admission or comorbidities and abnormal red cell distribution width, could facilitate better care and prevent mortality among patients with sepsis who are transferred from a rural, low-volume emergency department to an urban-high volume facility.Copyright © 2025 Elsevier Inc. All rights reserved.

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