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Tytuł pozycji:

Characteristics and Outcomes of Clinic Visits Immediately Preceding Sepsis Hospitalization.

Tytuł:
Characteristics and Outcomes of Clinic Visits Immediately Preceding Sepsis Hospitalization.
Autorzy:
Miller HC; H. Catherine Miller is a former internal medicine resident physician, University of Michigan, Ann Arbor. She is now an assistant professor of clinical medicine at Vanderbilt University Medical Center, Nashville, Tennessee.
Liu VX; Vincent X. Liu is a research scientist, Kaiser Permanente Northern California Division of Research, Oakland, California and an intensivist, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California.
Prescott HC; Hallie C. Prescott is an associate professor, Department of Internal Medicine, University of Michigan and a core investigator, US Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.
Źródło:
American journal of critical care : an official publication, American Association of Critical-Care Nurses [Am J Crit Care] 2021 Mar 01; Vol. 30 (2), pp. 135-139.
Typ publikacji:
Journal Article; Research Support, N.I.H., Extramural
Język:
English
Imprint Name(s):
Original Publication: Aliso Viejo Ca : American Association Of Critical-Care Nurses (AACN)
MeSH Terms:
Ambulatory Care*
Hospitalization*
Sepsis*/diagnosis
Sepsis*/epidemiology
Sepsis*/therapy
Adult ; Ambulatory Care Facilities ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; Prognosis ; ROC Curve ; Retrospective Studies ; Severity of Illness Index
References:
BMJ Open. 2018 Sep 17;8(9):e022832. (PMID: 30224394)
Am J Respir Crit Care Med. 2017 Oct 1;196(7):856-863. (PMID: 28345952)
N Engl J Med. 2017 Jun 8;376(23):2235-2244. (PMID: 28528569)
JAMA. 2017 Oct 3;318(13):1241-1249. (PMID: 28903154)
Ann Am Thorac Soc. 2015 Feb;12(2):216-20. (PMID: 25569845)
Lancet Infect Dis. 2015 May;15(5):581-614. (PMID: 25932591)
JAMA. 2014 Jul 2;312(1):90-2. (PMID: 24838355)
Crit Care Med. 2018 Apr;46(4):513-516. (PMID: 29309371)
JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338)
Grant Information:
K08 GM115859 United States GM NIGMS NIH HHS; R35 GM128672 United States GM NIGMS NIH HHS
Entry Date(s):
Date Created: 20210301 Date Completed: 20211015 Latest Revision: 20220302
Update Code:
20240105
PubMed Central ID:
PMC8789345
DOI:
10.4037/ajcc2021456
PMID:
33644806
Czasopismo naukowe
Background: Existing sepsis quality improvement initiatives focus on recognition and treatment of sepsis upon hospital admission. Yet many patients are evaluated in the clinic within 1 day of sepsis hospitalization.
Objectives: To determine the circumstances of clinic visits that precede sepsis hospitalization, including illness severity, whether patients are referred to the hospital, and time lapse and change in illness severity between clinic and hospital evaluation.
Methods: In a retrospective cohort study at a tertiary academic medical center, data from electronic medical records were collected for all adult patients evaluated in an outpatient clinic within 1 day of sepsis hospitalization in 2017.
Results: Of 1450 patients hospitalized with sepsis, 118 had an established outpatient provider and a clinic visit within 1 day of admission and thus were included. During the clinic visit, 47 patients (39.8%) had a quick Sequential Organ Failure Assessment (qSOFA) score ≥1, and 59 (50.0%) had vital sign abnormalities. Most (74, 62.7%) were sent directly to the emergency department or hospital. Upon emergency department/hospital presentation, 62 patients (52.5%) had a worsening qSOFA score and/ or vital signs and 27 (22.9%) had worsening of multiple parameters. Median time lapse from clinic to emergency department/hospital evaluation was 3.2 hours.
Conclusions: One in 10 patients hospitalized for sepsis had been evaluated in a clinic within 1 day of admission. At that clinic visit, most patients had an elevated qSOFA score or abnormal vital signs and a majority were sent directly to the emergency department/hospital. Half experienced clinical deterioration between the clinic visit and arrival in the emergency department/hospital.
(©2021 American Association of Critical-Care Nurses.)

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