• Stacey-Ann Whittaker, Barry D Fuchs, David F Gaieski, Jason D Christie, Munish Goyal, Nuala J Meyer, Craig Kean, Dylan S Small, Scarlett L Bellamy, and Mark E Mikkelsen.
• Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
• J Crit Care. 2015 Feb 1; 30 (1): 78-84.

PurposeThe purpose of this study was to detail the trajectory and outcomes of patients with severe sepsis admitted from the emergency department to a non-intensive care unit (ICU) setting and identify risk factors associated with adverse outcomes.Material And MethodsThis was a single-center retrospective cohort study conducted at a tertiary, academic hospital in the United States between 2005 and 2009. The primary outcome was a composite outcome of ICU transfer within 48 hours of admission and/or 28-day mortality.ResultsOf 1853 patients admitted with severe sepsis, 841 (45%) were admitted to a non-ICU setting, the rate increased over time (P < .001), and 12.5% of these patients were transferred to the ICU within 48 hours and/or died within 28 days. In multivariable models, age (P < .001), an oncology diagnosis (P < .001), and illness severity as measured by Acute Physiologic and Chronic Health Evaluation II (P = .04) and high (≥4 mmol/L) initial serum lactate levels (P = .005) were associated with the primary outcome.ConclusionsPatients presenting to the emergency department with severe sepsis were frequently admitted to a non-ICU setting, and the rate increased over time. Of 8 patients admitted to the hospital ward, one was transferred to the ICU within 48 hours and/or died within 28 days of admission. Factors present at admission were identified that were associated with adverse outcomes.Copyright © 2014 Elsevier Inc. All rights reserved.

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