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The epidemiology of adults with severe sepsis and septic shock in Scottish emergency departments
  1. Alasdair Gray1,
  2. Kirsty Ward2,
  3. Fiona Lees2,
  4. Colin Dewar3,
  5. Sarah Dickie4,
  6. Crawford McGuffie5,
  7. On behalf of the STAG steering committee
  1. 1Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Scottish Trauma Audit Group, NHS National Services Scotland, Paisley, UK
  3. 3Emergency Department, Victoria Hospital, Kirkcaldy, UK
  4. 4Emergency Department, Crosshouse Hospital, Kilmarnock, UK
  5. 5Emergency Department, Crosshouse Hospital, Kilmarnock, UK, and, Chairman of the Scottish Trauma Audit Group
  1. Correspondence to Dr Crawford McGuffie, Consultant in Emergency Medicine, Associate Medical Director, Ayrshire and Arran Health Board, Chairman, Scottish Trauma Audit Group, Emergency Department, Crosshouse Hospital, Kilmarnock KA2 OBE, UK; crawford.mcguffie{at}aaaht.scot.nhs.uk

Abstract

Background The Surviving Sepsis Campaign (SSC) promotes a bundle approach to the care of septic patients to improve outcome. Some have questioned the capability of delivering the bundle in emergency departments (EDs). The authors report the epidemiology and 6 h bundle compliance of patients with severe sepsis/septic shock presenting to Scottish EDs.

Methods Analysis of the previously reported Scottish Trauma Audit Group sepsis database was performed including 20 mainland Scottish EDs. A total of 308 910 attendances were screened (between 2 March and 31 May 2009), and 5285 of 27 046 patients were identified after case note review and included on the database. This analysis includes patients who had severe sepsis/septic shock before leaving the ED. Epidemiological, severity of illness criteria, and ED management data were analysed.

Results 626 patients (median age 73; M/F ratio 1:1; 637 presentations) met entrance criteria. The median number of cases per site was 16 (range 3–103). 561 (88.1%) patients arrived by ambulance. The most common source of infection was the respiratory tract (n=411, 64.5%) The most common physiological derangements were heart rate (n=523, 82.1%), respiratory rate (n=452, 71%) and white cell count (n=432, 67.8%). The median hospital stay was 9 days (IQR 4–17 days). 201 (31.6%) patients were admitted to critical care within 2 days, 130 (20.4%) directly from the ED. 180 patients (28.3%) died. There was poor compliance with all aspect of the SSC resuscitation bundle.

Conclusions Sepsis presentations are of variable frequency but have typical epidemiology and clinical outcomes. SSC bundle resuscitation uptake is poor in Scottish EDs.

  • Audit
  • care systems
  • clinical care
  • emergency department
  • infection
  • diagnosis
  • thromboembolic disease
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Footnotes

  • Members of the STAG steering committee are listed in online appendix 1.

  • Funding Scottish Trauma Audit Group (STAG) is part of the Quality Improvement Programme at ISD (Information Services Division), a division of NHS National Services Scotland. STAG was set up in 1991 to audit the management of seriously injured patients in Scotland. It achieved its aims and stopped collecting trauma data in 2002. Since then the team have worked on a range of national audit projects and during 2009/2010 completed an audit of sepsis management in Scotland. This report was published in November 2010 and is available on the STAG website http://www.stag.scot.nhs.uk along with further information on STAG and its current programme of work.

  • Competing interests None.

  • Patient consent Data are presented as part of a National Scottish Audit. All data were anonymised before submission to the STAG central team at ISD (Information Services Division). The Caldicott guardian of each participating health board was informed of the audit and the processes involved. ISD, as part of NHS National Services Scotland, employs strict rules around information governance and the protection of information. All health information is held securely, and managed according to data protection regulations.

  • Ethics approval The STAG Sepsis Audit did not involve anything being done to patients beyond normal clinical management; it therefore did not require formal ethical approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement ISD are the information custodians of the STAG sepsis database; however, all participating sites are actively encouraged to request access to their own site-specific data particularly for governance or management purposes. National level data are also available for governance or research purposes; however, release of such data is managed through a strict information governance and information security policy.

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