Aims/Objectives/Background Early treatment is advocated in the management of patients with suspected sepsis. We sought to understand the association between the emergency department (ED) treatments and outcome in these patients. The treatments studied were: (i) the time to antibiotics, (ii) the volume of intravenous fluid (IVF), (iii) mean arterial pressure (MAP) after 2,000 ml of IVF and (iv) the final MAP in the ED.

Methods/Design A retrospective analysis of the ED database of adult patients who met two SIRS criteria or one red flag sepsis criteria on arrival, received intravenous antibiotics for a suspected infection and admitted between February 2016 and August 2017, was performed. The primary outcome measure was all-cause in-hospital mortality. The four treatments stated above were controlled for severity of illness and subject to multivariate logistic regression and Cox proportional-hazard regression to identify independent predictors of mortality.

Results/Conclusions Of the 2,066 patients studied 272 (13.2%) died in hospital. The median time to antibiotics was 48 (Interquartile range 30–82) minutes. The time to antibiotics was an independent predictor of mortality only in those who developed refractory hypotension (RH); antibiotics administered more than 55 mins after arrival was associated with an odd-ratio (OR) for mortality of 2.75 [95% confidence interval (CI) 1.22–6.14]. The number-needed-to-treat was 4. IVF >2,000 ml (95%CI >500->2,100), except in RH, and a MAP≤66 mmHg after 2,000 mls of IVF were also independent predictors of mortality. The OR for mortality of IVF>2,000 ml in non-RH was 1.80 (95%CI 1.15–2.82); Number-needed-to-harm was 14. The OR for morality for a MAP≤66 mmHg after 2,000 ml of IVF was 3.42 (95%CI 2.10–5.57). A final MAP<75 mmHg in the ED was associated with, but not an independent predictor of mortality.

Antibiotics were time-critical only in refractory hypotension. Intravenous fluids >2,000 mls in non-RH and a MAP≤66 mmHg after 2,000 ml of IVF were also independent predictors of mortality.