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Sepsis in Brazilian emergency departments: a prospective multicenter observational study.
Machado, Flávia R; Cavalcanti, Alexandre B; Braga, Maria A; Tallo, Fernando S; Bossa, Aline; Souza, Juliana L; Ferreira, Josiane F; Pizzol, Felipe Dal; Monteiro, Mariana B; Angus, Derek C; Lisboa, Thiago; Azevedo, Luciano C P.
Afiliação
  • Machado FR; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil. frmachado@unifesp.br.
  • Cavalcanti AB; Anesthesiology, Pain and Intensive Care Department, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, SP, Brazil. frmachado@unifesp.br.
  • Braga MA; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil. frmachado@unifesp.br.
  • Tallo FS; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil.
  • Bossa A; Brazilian Research in Intensive Care Network (BRICNet), São Paulo, SP, Brazil.
  • Souza JL; HCor Research Institute, São Paulo, SP, Brazil.
  • Ferreira JF; Associação Brasileira de Medicina de Emergência, São Paulo, Brazil.
  • Pizzol FD; Associação Brasileira de Medicina de Urgência, São Paulo, Brazil.
  • Monteiro MB; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil.
  • Angus DC; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil.
  • Lisboa T; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil.
  • Azevedo LCP; Instituto Latino Americano de Sepse, R Pedro de Toledo 980 Cj 94, São Paulo, SP, 04039-002, Brazil.
Intern Emerg Med ; 18(2): 409-421, 2023 03.
Article em En | MEDLINE | ID: mdl-36729268
We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who remained there due to inadequate allocation. Allocation was considered adequate if the patient was transferred to the intensive care unit (ICU), ward, or remained in the ED without ICU admission requests. Prevalence was estimated using the total ED visit number. Prognostic factors were assessed with logistic regression. Of 33,902 ED visits in 74 institutions, 183 were acute admissions (prevalence: 5.4 sepsis per 1000 visits [95% confidence interval (CI): 4.6-6.2)], and 148 were already in the ED; totaling 331 patients. Hospital mortality was 32% (103/322, 95% CI 23.0-51.0). Age (odds ratio (OR) 1.22 [95% CI 1.10-1.37]), Sequential Organ Failure Assessment (SOFA) score (OR 1.41 [95% CI 1.28-1.57]), healthcare-associated infections (OR 2.59 [95% CI 1.24-5.50]) and low-resource institution admission (OR 2.65 [95% CI 1.07-6.90]) were associated with higher mortality. Accredited institutions (OR 0.42 [95% CI 0.21-0.86]) had lower mortality rates. Allocation within 24 h was adequate in only 52.8% of patients (public hospitals: 42.4% (81/190) vs. private institutions: 67.4% (89/132, p < 0.001) with 39.2% (74/189) of public hospital patients remaining in the ED until discharge, of whom 55.4% (41/74) died. Sepsis exerts high burden and mortality in Brazilian EDs with frequent inadequate allocation. Modifiable factors, such as resources and quality of care, are associated with reduced mortality.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sepse / Hospitalização Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do sul / Brasil Idioma: En Revista: Intern Emerg Med Assunto da revista: MEDICINA DE EMERGENCIA / MEDICINA INTERNA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Itália
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sepse / Hospitalização Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Humans País/Região como assunto: America do sul / Brasil Idioma: En Revista: Intern Emerg Med Assunto da revista: MEDICINA DE EMERGENCIA / MEDICINA INTERNA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Itália