By: William Baker, MD
THINK SEPSIS: SAVE LIVES
Scope of the problem
- Approximately 1 million patients in the United States are affected by severe sepsis (SS) annually
- Most common cause of death among critically ill patients in non-coronary intensive care units (1)
- Incidence of severe sepsis is estimated to be 300 cases per 100,000 population (1); MI incidence was 208 cases per 100,000 person-years in 2008(2)
- 570,000 ED visits/yr(1)
- 20%-30% in-hospital mortality(1,3), [comparison: mortality from MI < 8%(2)]
- 50% mortality for septic shock
- 140k to < 200k US sepsis related deaths annually(1,4)
- Associated with annual hospital costs of $24.3 billion (Hospitalizations, costs, and outcomes of SS in the United States 2003 to 2007)
- Almost half of patients with SS walk-in (non-EMS arrival) and 24% of them die inpatient (unpublished data from a study of a national Medicare cohort… abstract at SAEM this May)
What you can do
- Comply with the surviving sepsis campaign bundle
- SEP-1 measures this bundle performance
- Bundle compliance(5):
- Associated with a 25% relative risk reduction in mortality rate
- Every 10% increase in compliance and additional quarter of participation in bundle, associated with significant decrease in the odds ratio for hospital mortality
- North Shore-LIJ reduced overall sepsis mortality by approximately 50% in a six-year period (2008–2013; sustained through 2014) and increased compliance with sepsis resuscitation bundle elements in the EDs and inpatient units in the 11 acute care hospitals(6)
- 6% absolute mortality increase per hour of delayed antibiotics for hypotensive patients(7)
- SEP-1 flowsheet
- Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001 Jul;29(7):1303–10.
- Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010 Jun 10;362(23):2155–65.
- Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003 Apr 17;348(16):1546–54.
- Moore JX, Donnelly JP, Griffin R, Howard G, Safford MM, Wang HE. Defining Sepsis Mortality Clusters in the United States. Crit Care Med. 2016 Jul;44(7):1380–7.
- Levy MM, Rhodes A, Phillips GS, Townsend SR, Schorr CA, Beale R, et al. Surviving Sepsis Campaign: association between performance metrics and outcomes in a 7.5-year study. Crit Care Med. 2015 Jan;43(1):3–12.
- Doerfler ME, D’Angelo J, Jacobsen D, Jarrett MP, Kabcenell AI, Masick KD, et al. Methods for reducing sepsis mortality in emergency departments and inpatient units. Jt Comm J Qual Patient Saf. 2015 May;41(5):205–11.
- Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006 Jun;34(6):1589–96.