Performance protocols in the approach to the patient with sepsis in the emergency department
a systematic review with meta-analysis
DOI:
https://doi.org/10.29352/mill029e.25020Keywords:
sepsis, shock, septic, antibiotic prophylaxis, mortality, clinical protocolsAbstract
Introduction: Sepsis has become a major health problem affecting millions of people annually, and its early identification and appropriate treatment in the first hours is emergent. The implementation of protocols can improve outcomes, however this is still a subject under debate.
Objetive: To describe the impact of the use of protocols in emergency departments on the approach to patients with sepsis in order to reduce time to the first antibiotic and mortality.
Methods: A systematic review with meta-analysis was conducted following the methodology proposed by the Joanna Briggs Institute. Two independent reviewers performed the critical appraisal, extraction and synthesis of data.
Results: Seven studies were included. The results of the meta-analysis showed no differences in the mortality rate (all hospital time) (RR=0.84, 95%CI=0.63-1.14, p=0.27). However, for 30-day mortality there are significant differences favouring the group that used protocols in the approach to the sepsis patient (RR=0.80, 95%CI=0.68-0.95, p=0.01) and a reduction of time to antibiotics (MD=-41.83, 95%CI=-77.89- -5.77, p=0.02).
Conclusion: Emergency department protocols reduce mortality and the time until the first antibiotic is taken. Therefore, their implementation is essential to improve health outcomes.
Downloads
References
ARISE & ANZICS (2014). Goal-Directed Resuscitation for Patients with Early Septic Shock. The new england journal of medicine, 1-11. DOI: 10.1056/NEJMoa1404380
Bone, R.C., Balk, R.A., Cerra, F.B., Dellinger, R.F., Fein, A.M., Knaus, W.A., & Sibbald, W.J. (1992). Definitions for Sepsis and Organ Failure and Guidelines for the use of innovative therapies in Sepsis. Chest. 101. 1644-1655. DOI 10.1378/chest.101.6.1644
Carneiro, A. H., Andrade-Gomes, J., & Póvoa, P. (2016). Cara sépsis-3, lamentamos dizer-lho, mas não gostamos de si. Medicina Interna, 23(4), 56-60. http://www.scielo.mec.pt/pdf/mint/v23n4/v23n4a14.pdf
Delawder, J.M., & Hulton, L., (2019). An interdisciplinary code sepsis team to improve sepsis-bundle compliance: a quality improvement project. Journal of Emergency Nursing, 2019, 1-8. https://doi.org/10.1016/j.jen.2019.07.001
El Khuri, C., Dagher, G.A., Chami, A., Chebl, R.B., Amoun, T., Bachir, R., Jaafar, B., & Rizk, N. (2019). The Impact of EGDT on Sepsis Mortality in a Single Tertiary Care Center in Lebanon. Emergency Medicine International, 2019. 1-8. Disponível em: https://doi.org/10.1155/2019/8747282
Ferrer, R., Martin-Loeches, I., Phillips, G., Osborn, T.M., Townsend, S., Dellinger, R.P., Artigas, A., Schorr, C. & Levy, M.M. (2014). Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour: Results From a Guideline-Based Performance Improvement Program. Critical Care Medicine. 42 (8). 1749-1755. DOI: 10.1097/CCM.0000000000000330
Francis, M., Rich, T., Williamson, T., & Peterson, D. (2009). Effect of an emergency department sepsis protocol on time to antibiotics in severe sepsis. Canadian Journal of Emergency Medicine, 12(4), 303-10. https://doi.org/10.1017/S1481803500012380
Husabø, G., Nilsen, R.M., Flaatten, H., Solligård, E., Frich, J.C., Bondevik, G.T., Braut, G.S., Walshe, K., & Hovlid, E. (2019). Early diagnosis of sepsis in emergency departments, time to treatment, and association with mortality: An observational study. Plos One, 15(1). https://doi.org/10.1371/journal.pone.0227652
McColl, T., Gatien, M., Calder, L., Yadav, K., Tam, R., Ong, M., Taljaard, M., & Stiell, I. (2016). Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative. Canadian Journal of Emergency Medicine, 0 (0), 1-10. DOI 10.1017/cem.2016.351
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372, n71. https://doi.org/10.1136/bmj.n71
Peltan, I.D., Brown, S.M., Bledsoe, J.R., Sorensen, J., Samore, M.H., Allen, T.L., & Hough C.L. (2019). ED Door-to-Antibiotic Time and Long-term Mortality in Sepsis. Chest, 155(5), 938-946. https://doi.org/10.1016/j.chest.2019.02.008
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., Rochwerg, B., Rubenfeld, G. D., Angus, D. C., Annane, D., Beale, R. J., Bellinghan, G. J., Bernard, G. R., Chiche, J. D., Coopersmith, C., … Dellinger, R. P. (2017). Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Medicine, 43(3), 304-377. DOI: 10.1007/s00134-017-4683-6
Santos, E. J. F., & Cunha, M. (2013). Interpretação Crítica dos Resultados Estatísticos de uma Meta‐Análise: Estratégias Metodológicas. Millenium, 44, 85‐98.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J. D., Coopersmith, C. M., Hotchkiss, R. S., Levy, M. M., Marshall, J. C., Martin, G. S., Opal, S. M., Rubenfeld, G. D., Van der Poll, T., Vincent, J. L., & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 315(8), 801-810. DOI: 10.1001/jama.2016.0287.
Song, J., Cho, H., Park, D.W., Sejoong, A., Kim, J.Y., Seok, H., Park, J., & Moon, S. (2019). The Effect of the Intelligent Sepsis Management System on Outcomes among Patients with Sepsis and Septic Shock Diagnosed According to the Sepsis-3 Definition in the Emergency Department. Journal of Clinical Medicine, 8,1-12. DOI: 10.3390/jcm8111800
Tufanaru, C., Munn, Z., Aromataris, E., Campbell, J., & Hopp, L. (2017). Chapter 3: Systematic reviews of effectiveness. In E. Aromataris & Z. Munn (Eds.), Joanna Briggs Institute Reviewer's Manual: The Joanna Briggs Institute.
Tse, C.L., Lui, C.T., Wong, C.Y., Ong, K.L., Fung, H.T., & Tang., S.Y.H. (2017). Impact of a sepsis guideline in emergency department on outcome of patients with severe sepsis. Hong Kong Journal or Emergency Medicine, 24(3), 123-131. https://doi.org/10.1177/102490791702400302
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who submit proposals for this journal agree to the following terms:
a) Articles are published under the Licença Creative Commons (CC BY 4.0), in full open-access, without any cost or fees of any kind to the author or the reader;
b) The authors retain copyright and grant the journal right of first publication, allowing the free sharing of work, provided it is correctly attributed the authorship and initial publication in this journal;
c) The authors are permitted to take on additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, post it to an institutional repository or as a book), with an acknowledgment of its initial publication in this journal;
d) Authors are permitted and encouraged to publish and distribute their work online (eg, in institutional repositories or on their website) as it can lead to productive exchanges, as well as increase the impact and citation of published work
Documents required for submission
Article template (Editable format)
