Characteristics of patients who died in the hospital emergency service during the SARS-CoV-2 pandemic: a retrospective cohort study in a tertiary hospital in Spain.

The objective of this study is to analyze the characteristics of patients who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital, with a special focus on those who died due to SARS-CoV-2. A retrospective cohort study was conducted, including all patients over 18 years old who died in the Hospital Emergency Department (HED) of a Spanish third-level hospital located in Badalona, Spain, from Jun 2019 to Dec 2020. Various sociodemographic, clinical, and diagnostic variables of the patients were analyzed to identify potential risk factors associated with mortality. During the first wave of the COVID-19 pandemic, a total of 72 patients died in the HED, representing a 42% increase compared to the pre-pandemic period. Of the deceased patients, 11% were attributed to SARS-CoV-2. Furthermore, it was found that patients who died from SARS-CoV-2 during the first wave were significantly younger than those in the second wave, with an average age of 78.6 ± 3.1 years in the first wave and 91.8 ± 4.8 years in the second wave. No significant differences were found regarding gender or associated comorbidities. Overall, the mortality rate at the HED in relation to COVID-19 was low, and infected patients died at younger ages during the first wave compared to the second wave.

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.

[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.

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

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.