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The outcome of sepsis and septic shock presenting to the Emergency Department in Australia and New Zealand

Introduction

The outcome of sepsis and septic shock patients admitted to the ICU from the Emergency Department (ED) in Australia and New Zealand was investigated using prospectively collected data from the Australian and New Zealand Intensive Care Society Adult Patient Database.

Methods

All adult patients with an APACHE III medical admission diagnosis of nonurinary or urinary sepsis, or nonurinary or urinary sepsis with shock, admitted directly to the ICU from the ED between 1 January 1997 and 31 December 2005 were identified. Predictor variables for hospital mortality were analysed using logistic regression with cross-validation (80% determination and 20% validation) and robust, cluster-specific (ICU site) standard errors.

Results

A total of 7,649 patients (54% male) of mean (SD) age 60.2 (18.1) years and APACHE III score 74.0 (34.7) were identified. The number of patients admitted per year increased progressively (1997, n = 368 (7.7 admissions per contributing ICU); 2005, n = 1,409 (14.0 admissions per contributing ICU)). Nonurinary sepsis with shock was the most common admission diagnosis (n = 3,394, 44.4%) and urinary sepsis with shock the least common (n = 607, 7.9%). Overall ICU mortality and hospital mortality were 20.9% and 27.6%, respectively. Hospital mortality was predicted by hospital type (tertiary: 0.67 (0.51–0.90), P = 0.007; metropolitan: 0.63 (0.48–0.83), P = 0.001; private: 0.65 (0.47–0.91), P = 0.011; reference category rural), age (1.026 (1.019–1.034), P = 0.0001), APACHE III score (1.043 (1.038–1.048), P = 0.0001) and APACHE III score squared (P = 0.032), sepsis category (nonurinary shock versus the other three categories combined, 1.79 (1.48–2.16), P = 0.001), mechanical ventilation within 24 hours of ICU admission (1.38 (1.14–1.66), P = 0.001) and calendar year as a single main linear effect (0.94 (0.90–0.97), P = 0.0001). Significant interactions were demonstrated between (i) sepsis classification and calendar year (linear decrease in mortality, nonurinary shock × year 0.92 (0.86–0.99), P = 0.019), (ii) sepsis classification and age (nonurinary shock × age 0.986 (0.977–0.996), P = 0.008), and (iii) ventilation and time from hospital to ICU admission (<4.5 hours or ≥4.5 hours 1.38 (1.12–1.69), P = 0.002). The model ROC curve area and the P value for the Hosmer–Lemeshow C statistic were 0.86 and 0.37, respectively. Restricting the model to only those ICUs that contributed data for all 9 years of the study period yielded similar parameter estimates, including calendar year effect.

Conclusion

The reported incidence of sepsis and septic shock in ICU patients presenting to the ED in Australia and New Zealand has increased since 1997; hospital mortality has decreased. These data require confirmation with a prospective study.

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Peake, S., Moran, J. The outcome of sepsis and septic shock presenting to the Emergency Department in Australia and New Zealand. Crit Care 11, P73 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5233

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Keywords

  • Emergency Department
  • Septic Shock
  • Hospital Mortality
  • Septic Shock Patient
  • Care Society