Sepsis Prevalence and Outcome on the General Wards and Emergency Departments in Wales: Results of a Multi-Centre, Observational, Point Prevalence Study

• DOI: 10.1371/journal.pone.0167230
• Publication Date: 2016-12-01T19:22:21Z
• Authors: Tamas Szakmany; Robert M. Lundin; Ben Sharif; Gemma Ellis; Paul Morgan; Maja Kopczynska; Amrit Dhadda; Charlotte Mann; Danielle Donoghue; Sarah Rollason; Emma Brownlow; Francesca Hill; Grace Carr; Hannah Turley; James Hassall; James Lloyd; Llywela Davies; Michael Atkinson; Molly Jones; Nerys Jones; Rhodri Martin; Yousef Ibrahim; Judith E. Hall
• Keywords: Male; Science; 610; Comorbidity; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Sepsis; Patients' Rooms; Prevalence; Humans; Aged; Aged, 80 and over; Cross Infection; Wales; Q; R; Middle Aged; R1; 3. Good health; Patient Outcome Assessment; Logistic Models; Medicine; Female; Emergency Service, Hospital; Research Article

Data on sepsis prevalence on the general wards is lacking on the UK and in the developed world. We conducted a multicentre, prospective, observational study of the prevalence of patients with sepsis or severe sepsis on the general wards and Emergency Departments (ED) in Wales. During the 24-hour study period all patients with NEWS≥3 were screened for presence of 2 or more SIRS criteria. To be eligible for inclusion, patients had to have a high clinical suspicion of an infection, together with a systemic inflammatory response (sepsis) and evidence of acute organ dysfunction and/or shock (severe sepsis). There were 5317 in-patients in the 24-hour study period. Data were returned on 1198 digital data collection forms on patients with NEWS≥3 of which 87 were removed, leaving 1111 for analysis. 146 patients had sepsis and 144 patients had severe sepsis. Combined prevalence of sepsis and severe sepsis was 5.5% amongst all in-patients. Patients with sepsis had significantly higher NEWS scores (3 IQR 3-4 for non-sepsis and 4 IQR 3-6 for sepsis patients, respectively). Common organ dysfunctions in severe sepsis were hypoxia (47%), hypoperfusion (40%) and acute kidney injury (25%). Mortality at 90 days was 31% with a median (IQR) hospital free stay of 78 (36-85) days. Screening for sepsis, referral to Critical Care and completion of Sepsis 6 bundle was low: 26%, 16% and 12% in the sepsis group. Multivariable logistic regression analysis identified higher National Early Warning Score, diabetes, COPD, heart failure, malignancy and current or previous smoking habits as independent variables suggesting the diagnosis of sepsis. We observed that sepsis is more prevalent in the general ward and ED than previously suggested before and that screening and effective treatment for sepsis and severe sepsis is far from being operationalized in this environment, leading to high 90 days mortality.