Patient characteristics of patients in groups with full and incomplete compliance
| Total cohort | Full compliance | Incomplete compliance | p Value | |
| Demographics | ||||
| N (%) | 1732 (100) | 719 (41.5) | 1013 (58.5) | |
| Age, mean (SD) | 61.3 (16.7) | 62.2 (16.4) | 60.6 (17.0) | 0.259 |
| Gender (male), n (%) | 977 (56.4) | 411 (57.2) | 566 (55.9) | 0.594 |
| Evaluated at the University Medical Centre, n (%) | 1258 (72.6) | 469 (65.2) | 789 (77.9) | <0.001 |
| Comorbidities, n (%) | ||||
| COPD | 273 (15.8) | 142 (19.7) | 131 (12.9) | <0.001 |
| Heart failure | 222 (12.8) | 92 (12.8) | 130 (12.9) | 0.982 |
| Liver disease | 78 (4.5) | 27 (3.8) | 51 (5.0) | 0.206 |
| Renal disease | 296 (17.1) | 118 (16.4) | 178 (17.6) | 0.527 |
| Nursing home resident | 111 (6.4) | 44 (6.1) | 67 (6.6) | 0.679 |
| Immunocompromised (1) | 685 (39.5) | 228 (31.7) | 457 (45.1) | <0.001 |
| Malignancy (no metastases) | 204 (11.8) | 69 (9.6) | 13.5 (13.3) | 0.018 |
| Malignancy (with metastases) | 211 (12.2) | 64 (8.9) | 147 (14.5) | <0.001 |
| DNR status (%) (5) | 360 (20.8) | 145 (20.2) | 215 (21.2) | 0.558 |
| Illness severity | ||||
| Triage category, median (IQR) (2) | 4 (3–4) | 3 (3–4) | 3 (3–4) | 0.075 |
| Total predisposition (P) and infection (I) score, median (IQR) | 4 (3–6) | 4 (3–6) | 4 (3–6) | 0.555 |
| Total response (R) and organ failure (O) score, median (IQR) | 6 (2–8) | 6 (2–8) | 5 (2–8) | 0.130 |
| Total PIRO score, median (IQR) | 9.7 (6–14) | 9.9 (6–14) | 9.6 (5–13) | 0.179 |
| Acute-onset organ failure, n (%) | 353 (20.4) | 132 (18.4) | 221 (21.8) | 0.078 |
| Number of acute failing organs, median (IQR) | 0 (0–0) | 0 (0–0) | 0 (0–0) | |
| Admission to ICU, n (%) (4) | 178 (10.3) | 74 (10.3) | 104 (10.3) | 0.982 |
| Vital signs at ED presentation | ||||
| Systolic blood pressure, mean (SD) (236) | 132.6 (26.2) | 134.7 (26.4) | 131.1 (26.0) | 0.659 |
| Heart rate, mean (SD) (43) | 108.4 (19.8) | 109.5 (19.5) | 107.7 (20.0) | 0.504 |
| Respiratory rate, mean (SD) (515) | 24 (19–30) | 25.4 (7.7) | 24.4 (7.6) | 0.620 |
| Oxygen saturation, mean (SD) (67) | 95.2 (4.9) | 94.8 (5.5) | 95.4 (4.4) | 0.053 |
| Temperature (°C), mean (SD) (41) | 38.7 (1.9) | 38.9 (2.4) | 38.6 (1.6) | 0.724 |
| Laboratory analysis at ED presentation | ||||
| Lactate (mmol/L), median (IQR) (228) | 1.8 (1.3–2.5) | 1.7 (1.3–2.4) | 1.8 (1.4–2.7) | 0.004 |
| Platelets (×109/L), median (IQR) (37) | 207 (151–276) | 207 (160–272) | 207 (146–279) | 0.362 |
| INR median (IQR), (690) | 1.1 (1–1.5) | 1.1 (1.0–1.3) | 1.1 (1.0–1.6) | 0.001 |
| Creatinine (µg/L), median (IQR) (14) | 87 (67–120) | 86 (67–117) | 88 (67–122) | 0.265 |
| Urea (mmol/L), median (IQR) (15) | 7 (5.1–10.3) | 6.8 (5.0–9.9) | 7.1 (5.1–0.5) | 0.164 |
| Bilirubin (µmol/L), median (IQR) (418) | 12 (8–18) | 12 (8–18) | 12 (8–19) | 0.742 |
| Quality performance measures | ||||
| Time to antibiotics (min), median (IQR) (34) | 100 (54–164) | 79 (47–121) | 124 (65–218) | <0.001 |
| Amount of intravenous fluids administered (L), median (IQR) (5) | 1 (0.5–1.5) | 1 (0.5–1.5) | 1 (0.5–1.5) | |
| Appropriate antibiotics given, n (%) (42) | 1387 (80.1) | 719 (100) | 668 (65.9) | <0.001 |
| Lactate measured within 6 hours, n (%) | 1504 (86.8) | 719 (100) | 785 (77.5) | <0.001 |
| Blood cultures drawn before antibiotics administration, n (%) | 1639 (94.6) | 719 (100) | 920 (90.8) | <0.001 |
| Antibiotics administered within 3 hours, n (%) (34) | 1374 (79.3) | 719 (100) | 655 (64.7) | <0.001 |
| Mean arterial pressure ≥65 mm Hg within 6 hours, n (%) (13) | 1650 (95.3) | 719 (100) | 931 (91.9) | <0.001 |
| Sufficient* fluid administration circulatory organ failure, n (%) (5) | 1653 (95.4) | 719 (100) | 934 (92.2) | <0.001 |
| Necessary consultation with ICU attending, n (%) (55) | 1663 (96.0) | 719 (100) | 949 (93.7) | <0.001 |
| Correct ED diagnosis, n (%) (17) | 1448 (83.6) | 719 (100) | 729 (72.0) | <0.001 |
| Unanticipated transfer from ward to ICU, n (%) (74) | 74 (4.3) | 0 (0) | 74 (7.3) | <0.001 |
| In-hospital mortality, n (%) | 130 (7.5%) | 27 (3.8%) | 103 (10.2% | <0.001 |
Patient characteristics were similar in ED patients in whom all quality performance measures were achieved (full compliance group) and in whom eight or less quality performance measures were achieved (incomplete compliance group).
*Administration of at least 1.5 L of fluids in the case of shock, in accordance with the SSC recommendations.8
Any amount of fluids was considered sufficient as long as an ED patient did not have signs of shock, that is, lactate >4 mmoL/L and/or systolic blood pressure <90 mm Hg or a decrease of the systolic blood pressure of >40 mm Hg compared with the baseline blood pressure of the ED patient.
COPD, chronic obstructive pulmonary disease; DNR, do not resuscitate order; ICU, intensive care unit; INR, international normalized ratio; PIRO, predisposition, infection, response, organ failure illness severity score; SSC, surviving sepsis campaign.