Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome.

AIMS: We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before hospitalization. METHODS AND RESULTS: We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population [35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51-9.41]. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65-1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97-2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66-4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations. CONCLUSIONS: PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.

[Sepsis Code in emergency department: Performance of q-SOFA score compared to SIRS score]. / Activación del Código Sepsis en urgencias: rendimiento de la escala q-SOFA respecto los criterios SIRS.

INTRODUCTION: The early diagnosis and treatment of sepsis remains a challenge in hospital emergency departments. OBJECTIVE: The objective was to evaluate the performance of the qSOFA (quick Sequential related Organ Failure Assessment) for activating a Sepsis Code in the emergency department, compared to applying previous criteria based on SIRS (Systemic Inflammatory Response Syndrome). METHODS: Patients ≥18years were included who consulted an emergency department of a tertiary hospital over two periods of time (May-October 2015), using SIRS criteria (SIRS Group) and over the same months in 2017 using qSOFA criteria (qSOFA Group). RESULTS: One hundred and five episodes were analysed: 70 corresponded to the SIRS Group and 55 to the qSOFA Group. The groups were comparable in terms of history, with a greater presence of neoplastic disease in the qSOFA Group. No differences were observed in the form of presentation, the action taken in the emergency department, admissions to critical care units, use of vasopressors or mean hospital stay between the two groups. A higher 30-day mortality rate was observed in the qSOFA group (21.81% vs. 4.3%; P=.003). In the multivariate study, neoplastic disease was noteworthy as an independent factor of poor prognosis (OR 5.36; P=.01), and activation using the SIRS criteria as a factor of good prognosis (OR .15; P=.021). CONCLUSIONS: The activation of the Sepsis Code using qSOFA criteria results in a reduction in detection, with greater associated mortality. Other complementary tools need to be sought for the early detection of sepsis in the emergency department.

Activation of a code sepsis in the emergency department is associated with a decrease in mortality. / La activación de un código sepsis en urgencias se asocia a una menor mortalidad.

OBJECTIVES: To 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. METHOD: All 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). RESULTS: A 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. CONCLUSIONS: The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.

Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections. / Poder pronóstico de mortalidad a corto plazo de los biomarcadores en los ancianos atendidos en Urgencias por infección.

OBJECTIVES: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]). METHODS: A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days). RESULTS: The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P<.001) with a prognostic cut-off>2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score≥2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA≥2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P<.001) with the best prognostic performance with sensitivity of 69% and specificity of 97% CONCLUSIONS: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA≥2 plus MR-proADM>2.07nmol/l) increased the predictive power of qSOFA.

[Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators]. / Impacto de la creación de una unidad de corta estancia (UCE) dependiente orgánicamente de urgencias en la gestión clínica y la calidad asistencial hospitalaria.

OBJECTIVES: The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. MATERIAL AND METHODS: Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively. and asked them to complete a questionnaire on patient satisfaction. RESULTS: A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. CONCLUSION: Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions.

OBJETIVO: El objetivo principal fue estudiar el impacto de la creación de una unidad de corta estancia (UCE) en los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional. El objetivo secundario fue conocer los resultados de estos mismos indicadores en la UCE y la satisfacción de los pacientes ingresados en ella. METODO: Estudio cuasiexperimental que comparó dos periodos de tiempo antes y después de la puesta en marcha de una UCE en un hospital universitario de tercer nivel: 1) Periodo 1: sin UCE (2012); 2) Periodo 2: con UCE (2013- 2015). Para el objetivo principal, se seleccionaron los episodios de pacientes ingresados en el hospital, pertenecientes a los cinco grupos relacionados con diagnóstico (GRD) que más frecuentemente ingresan en la UCE, desde 2012 a 2015. Para el objetivo secundario, se seleccionaron todos los episodios de pacientes ingresados en la UCE de 2013 a 2015. Se recogieron de forma retrospectiva datos de calidad y gestión clínica. Se realizó una encuesta de satisfacción en una muestra de pacientes ingresados en la UCE. RESULTADOS: Se incluyeron 76.241 ingresos hospitalarios. 19.090 en el periodo 1 y 57.151 en periodo 2, de los cuales 2.705 fueron en la UCE. En el periodo con UCE disminuyó la estancia media del hospital (IRR 0,93; IC95% 0,91-0,95) y de las áreas médicas (IRR 0,94; IC95% 0,92-0,96) sin un incremento en los resultados adversos. La estancia media de la UCE se ha mantenido por debajo de los 3 días con un incremento del peso medio (IRR 1,08; IC95% 1,05-1,11). Se contestaron 320 encuestas (11,8% del total de pacientes ingresados) y todos los aspectos fueron puntuados de forma muy sobresaliente. CONCLUSIONES: En nuestra experiencia, la apertura de una UCE podría contribuir a mejorar los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional en aquellos GRD más frecuentemente ingresados en la UCE.

Poder pronóstico de mortalidad a corto plazo de los biomarcadores en los ancianos atendidos en Urgencias por infección / Prognostic power of biomarkers for short-term mortality in the elderly patients seen in Emergency Departments due to infections

Objetivos: Analizar y comparar el poder predictivo de mortalidad a 30 días de varios biomarcadores (proteína C reactiva, procalcitonina, lactato, suPAR y proadrenomedulina) en los pacientes ancianos que acuden al servicio de Urgencias (SU) por un episodio de infección. Y, secundariamente, comprobar si estos mejoran la capacidad pronóstica de los criterios de sepsis (síndrome de respuesta inflamatoria sistémica y quick Sepsis-related Organ Failure Assessment [qSOFA]). Métodos: Estudio observacional, prospectivo, multicéntrico y analítico. Se incluyó consecutivamente a pacientes de 75 o más años atendidos en 8 SU por un proceso infeccioso. Se analizaron 25 variables independientes (epidemiológicas, de comorbilidad, funcionales, clínicas y analíticas) que pudieran influir en la mortalidad a corto plazo (30 días). Resultados: Se incluyó a 136 pacientes, de los que 13 (9,5%) habían fallecido a los 30 días tras su consulta en el SU. La MRproADM es el biomarcador que consigue la mayor área bajo la curva ROC para predecir mortalidad a los 30 días (0,864; IC 95% 0,775-0,997; p < 0,001), con un punto de corte de mayor capacidad predictiva de 2,07 nmol/l, que ofrece una sensibilidad del 77% y una especificidad del 96%. La escala qSOFA ≥ 2 consigue un área bajo la curva ROC de 0,763 (IC 95% 0,623-0,903; p = 0,002), con una sensibilidad del 76% y una especificidad del 75%. El modelo combinado (MRproADM con qSOFA ≥2 ) mejora el área bajo la curva ROC a 0,878 (IC 95% 0,749-1; p < 0,001) y ofrece el mejor rendimiento pronóstico, con una sensibilidad del 69% y una especificidad del 97%. Conclusiones: En los pacientes ancianos que acuden al SU por un episodio de infección, la MRproADM presenta una capacidad pronóstica de mortalidad a los 30 días superior al resto de los biomarcadores, la qSOFA obtiene mayor rendimiento que los criterios de síndrome de respuesta inflamatoria sistémica, y el modelo combinado qSOFA ≥ 2 con MRproADM > 2,07nmol/l mejora el poder predictivo de qSOFA

Objectives: To analyse and compare 30-day mortality prognostic power of several biomarkers (C-reactive protein, procalcitonin, lactate, suPAR and pro-adremomedullin) in elderly patients seen in Emergency Departments (ED) due to infections. Secondly, if these could improve the prognostic accuracy of sepsis criteria (systemic inflammatory response syndrome and quick Sepsis-related Organ Failure Assessment [qSOFA]). Methods: A prospective, observational, multicentre and analytical study. Patients aged 75 years and older who were treated for infection in the ED of 8 participating hospitals were enrolled consecutively. An assessment was made of 25 independent variables (epidemiological, comorbidity, functional, clinical and analytical variables) that could influence short-term mortality (at 30 days). Results: The study included 136 patients, 13 (9.5%) of whom died within 30 days of visiting the ED. MR-proADM is the biomarker with the best area under the curve ROC to predict 30-day mortality (0.864; 95% CI 0.775-0.997; P <.001) with a prognostic cut-off > 2.07nmol/l, sensitivity of 77% and specificity of 96%. The qSOFA score ≥ 2 had an area under the curve ROC of 0.763 (95% CI 0.623-0.903; P=.002), sensitivity of 76% and specificity of 75%. The mixed model (MR-proADM plus qSOFA ≥ 2) improved the area under the curve ROC to 0.878 (95% CI 0.749-1; P < .001) with the best prognostic performance with sensitivity of 69% and specificity of 97%. Conclusions: MR-proADM showed the best performance for 30-day mortality prognostic power compared to other biomarkers in elderly patients seen in EDs due to infections. qSOFA score achieves better results than systemic inflammatory response syndrome, and the mixed model (qSOFA ≥ 2 plus MR-proADM > 2.07nmol/l) increased the predictive power of qSOFA

Activación del Código Sepsis en urgencias: rendimiento de la escala q-SOFA respecto los criterios SIRS / Sepsis Code in emergency department: Performance of q-SOFA score compared to SIRS score

Introducción:El diagnóstico y el tratamiento precoces de la sepsis sigue siendo un reto en los servicios de urgencias hospitalarios.Objetivo:El objetivo es evaluar el rendimiento de la escala quick Sequential related Organ Failure Assessment (qSOFA) para la activación de un Código Sepsis en urgencias, respecto la aplicación de los criterios previos basados en los parámetros Systemic Inflammatory Response Syndrome (SIRS).Métodos:Se incluyeron los pacientes ≥18años que consultaron en un servicio de urgencias de un hospital de tercer nivel durante dos períodos de tiempo (mayo-octubre de 2015) mediante criterios SIRS (grupo SIRS), y en los mismos meses de 2017 mediante criterios qSOFA (grupo qSOFA).Resultados:Se analizaron 125 episodios: 70 correspondieron al grupo SIRS y 55 al grupo qSOFA. Los grupos fueron comparables respecto a antecedentes, con mayor presencia de enfermedad neoplásica en el grupo qSOFA. No se evidenciaron diferencias en la forma de presentación, la actuación realizada en urgencias, los ingresos en unidades de críticos, el uso de vasopresores o la estancia media hospitalaria entre los dos grupos. Sí se objetivó una mayor tasa de mortalidad a 30días en el grupo qSOFA (21,81% vs 4,3%; p=0,003). En el estudio multivariado destaca la enfermedad neoplásica como factor independiente de mal pronóstico (OR:5,36; p=0,01), y la activación mediante criterios SIRS como factor de buen pronóstico (OR:0,15; p=0,021).Conclusiones:La activación del Código Sepsis mediante criterios qSOFA comporta una disminución en la detección, con mayor mortalidad asociada. Es necesario buscar otras herramientas complementarias para la detección precoz de la sepsis en urgencias.(AU)

Introduction:The early diagnosis and treatment of sepsis remains a challenge in hospital emergency departments.Objective:The objective was to evaluate the performance of the qSOFA (quick Sequential related Organ Failure Assessment) for activating a Sepsis Code in the emergency department, compared to applying previous criteria based on SIRS (Systemic Inflammatory Response Syndrome).Methods:Patients ≥18years were included who consulted an emergency department of a tertiary hospital over two periods of time (May-October 2015), using SIRS criteria (SIRS Group) and over the same months in 2017 using qSOFA criteria (qSOFA Group).Results:One hundred and five episodes were analysed: 70 corresponded to the SIRS Group and 55 to the qSOFA Group. The groups were comparable in terms of history, with a greater presence of neoplastic disease in the qSOFA Group. No differences were observed in the form of presentation, the action taken in the emergency department, admissions to critical care units, use of vasopressors or mean hospital stay between the two groups. A higher 30-day mortality rate was observed in the qSOFA group (21.81% vs. 4.3%; P=.003). In the multivariate study, neoplastic disease was noteworthy as an independent factor of poor prognosis (OR 5.36; P=.01), and activation using the SIRS criteria as a factor of good prognosis (OR .15; P=.021).Conclusions:The activation of the Sepsis Code using qSOFA criteria results in a reduction in detection, with greater associated mortality. Other complementary tools need to be sought for the early detection of sepsis in the emergency department.

Impacto de la creación de una unidad de corta estancia (UCE) dependiente orgánicamente de urgencias en la gestión clínica y la calidad asistencial hospitalaria / Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators

Objetivo. El objetivo principal fue estudiar el impacto de la creación de una unidad de corta estancia (UCE) en los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional. El objetivo secundario fue conocer los resultados de estos mismos indicadores en la UCE y la satisfacción de los pacientes ingresados en ella. Método. Estudio cuasiexperimental que comparó dos periodos de tiempo antes y después de la puesta en marcha de una UCE en un hospital universitario de tercer nivel: 1) Periodo 1: sin UCE (2012); 2) Periodo 2: con UCE (2013-2015). Para el objetivo principal, se seleccionaron los episodios de pacientes ingresados en el hospital, pertenecientes a los cinco grupos relacionados con diagnóstico (GRD) que más frecuentemente ingresan en la UCE, desde 2012 a 2015. Para el objetivo secundario, se seleccionaron todos los episodios de pacientes ingresados en la UCE de 2013 a 2015. Se recogieron de forma retrospectiva datos de calidad y gestión clínica. Se realizó una encuesta de satisfacción en una muestra de pacientes ingresados en la UCE. Resultados. Se incluyeron 76.241 ingresos hospitalarios. 19.090 en el periodo 1 y 57.151 en periodo 2, de los cuales 2.705 fueron en la UCE. En el periodo con UCE disminuyó la estancia media del hospital (IRR 0,93; IC95% 0,91-0,95) y de las áreas médicas (IRR 0,94; IC95% 0,92-0,96) sin un incremento en los resultados adversos. La estancia media de la UCE se ha mantenido por debajo de los 3 días con un incremento del peso medio (IRR 1,08; IC95% 1,05-1,11). Se contestaron 320 encuestas (11,8% del total de pacientes ingresados) y todos los aspectos fueron puntuados de forma muy sobresaliente. Conclusiones. En nuestra experiencia, la apertura de una UCE podría contribuir a mejorar los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional en aquellos GRD más frecuentemente ingresados en la UCE (AU)

Objective. The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. Material and method. Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively and asked them to complete a questionnaire on patient satisfaction. Results. A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. Conclusions. Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions (AU)

La activación de un código sepsis en urgencias se asocia a una menor mortalidad / Activation of a code sepsis in the emergency department is associated with a decrease in mortality

Objetivos: Evaluar el impacto de la implantación de un código sepsis (CS) en la evolución de pacientes con sepsis grave (SG)/shock séptico (SS). Determinar los factores independientes asociados a mortalidad. Método: Estudio de cohortes de pacientes con diagnóstico de SG/SS que consultaron en urgencias de un hospital terciario durante 6 meses. Se analiza el cumplimiento de las recomendaciones de la Surviving Sepsis Campaign, la estancia media, el ingreso en críticos y la mortalidad a 30 días. Se comparan 2 grupos: activación CS (A) y no activación (NA). Resultados: Se detectaron 114 episodios, 61,4% del grupo A y 38,6% del NA. El grupo A presenta con mayor frecuencia presión arterial sistólica<90mmHg (61,5% vs 34,4%; p=0,005) y el NA mayor elevación del lactato>3mmol/l (48,3% vs 80%; p=0,01) y foco abdominal (34,3% vs 13%; p=0,01). En el grupo A más frecuentemente se cursaron hemocultivos en la primera hora (95% vs 41,7%; p<0,001), se inició antibiótico precoz (76,9% vs 25%; p=0,005), se hizo reposición hídrica inicial (54,5% vs 18,2%; p=0,01) y se cumplieron globalmente los objetivos (31,4% vs 9,1%; p=0,006). El grupo NA tuvo mayor necesidad de ingreso en críticos (10% vs 36,4%; p<0,001), estancia hospitalaria (10,2días; desviación estándar 6,9 vs 14,4días; desviación estándar 5,8; p<0,001) y mortalidad (4,3% vs 34,1%; p<0,001). Una determinación de proteína C reactiva>200mg/l (odds ratio 33,7; p<0,001) y la no activación del código (odds ratio 13,3; p=0,001) resultaron factores independientes asociados a mortalidad. Conclusiones: La implantación de un CS mejora el cumplimiento de las recomendaciones y se asocia a una reducción de los ingresos en unidades de críticos, estancia media y mortalidad. La elevación de la proteína C reactiva y la no activación del código son factores independientes asociados a mortalidad. Existe un gran margen de mejora en la detección de los pacientes con SG/SS, así como en la optimización del tratamiento inicial en urgencias

Objectives: To 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. Method: All 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). Results: A 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. Conclusions: The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality