論文No1546
Three-Hour Bundle Compliance and Outcomes in Patients With Undiagnosed Severe Sepsis
Amanda S. Deis, BS, MSCR, Bristol B. Whiles, MD, Alexandra R. Brown, MS, Catherine L. Satterwhite, PhD, MSPH, MPH, Steven Q. Simpson, MD'Correspondence information about the author MD Steven Q. Simpson
CHEST, Volume 153, Issue 1, Pages 39–45, 2018.
＜背景＞
この研究の目的は敗血症特異的診断コードを受けた人と受けてない人とでSurviving Sepsis Campaignの3時間治療推奨の完遂と患者中心のアウトカムの比較を行うことである。
＜方法＞
大学病院のメディカルセンターのEDに入院し、抗菌薬投与をうけ、重症敗血症の基準を満たした成人患者の後ろ向きコホート解析である。
重症敗血症と診断された群とされていない群でSurviving Sepsis Campaignの３時間治療推奨を患者中心アウトカムに沿って比較した。
＜結果＞
全体で5631名が登録された(60.6 ± 17.2 years of age; 48.9% women)。
半分以下(32.8%)が国際疾患分類第9版の診断コード995.92の診断を受けていた。
３時間未満の４つのバンドル要素の基準を全部満たしていたのは少なかった(8.72%)。
治療要素（広域抗菌薬、輸液）はまだ多めだった(31.3%)。
診断コードを受けた群では４つのバンドル要素をより満たし(10.2% vs 7.9%; P < .005)、治療要素も頻度は高かった(36.0% vs 29.0%; P < .001)。
診断コードを満たした患者は死亡率が高く (6.3% vs 2.3%)、ICU入室率が高く(44.7% vs 22.5%)、入院期間が長かった(9.2 ± 6.9 days vs 6.9 ± 6.7 days) （すべてp < 0.001)。
＜感想＞
重症敗血症と診断されている割合は依然として低かったようです。
重症敗血症の診断コードを満たすと死亡率が高かったことから、きちんと診断する重要性が示唆されます。
Background
The aim of this study was to compare completion of the Surviving Sepsis Campaign 3-hour treatment recommendations and patient-centered outcomes between patients with severe sepsis who received a sepsis-specific diagnosis code with those who did not.
Methods
This was a retrospective cohort analysis of adult patients admitted through an academic medical center ED who received an antibiotic and met criteria for severe sepsis. We measured and compared the Surviving Sepsis Campaign 3-hour treatment recommendations along with patient-centered outcomes in patients who were diagnosed with severe sepsis and those who were not.
Results
A total of 5,631 patients were identified (60.6 ± 17.2 years of age; 48.9% women). Less than half (32.8%) received an International Classification of Diseases, ninth revision, diagnosis code of 995.92. Completion of all four bundle components in < 3 hours was low for all patients (8.72%). Therapeutic components (a broad-spectrum antibiotic and IV fluids) were completed more often (31.3%). Those with a diagnosis code received all four bundle components (10.2% vs 7.9%; P < .005), as well as therapeutic components at a higher frequency (36.0% vs 29.0%; P < .001). Patients with a diagnosis code had higher mortality (6.3% vs 2.3%), more frequent ICU admissions (44.7% vs 22.5%), and longer hospitalizations (9.2 ± 6.9 days vs 6.9 ± 6.7 days) than did patients with severe sepsis with no diagnosis code (all P < .001).
Conclusions
Severe sepsis continues to be an underdiagnosed and undertreated condition. Patients who were diagnosed had higher treatment rates yet experienced worse outcomes. Continued investigation is needed to identify factors contributing to diagnosis, treatment, and outcomes in patients with severe sepsis.