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Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery

机译:在紧急普外科中遵守脓毒症六指南的多中心观察性研究

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摘要

BackgroundEvidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency.MethodsPatients aged 16 years or more presenting with emergency general surgery problems were identified over a 7-day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days).ResultsOf a total of 5067 patients from 97 hospitals across the UK, 911 (18·0 per cent) fulfilled the criteria for sepsis, 165 (3·3 per cent) for severe sepsis and 24 (0·5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17·6–94·5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19·8 (i.q.r. 10·0–35·4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality.ConclusionAlthough sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent.
机译:背景基于证据的干预措施可以降低手术患者的死亡率。这项研究记录了在急诊的普通外科患者中脓毒症的患病率,对脓毒症的治疗指南的遵守以及源控制的时机。方法在16天或更长时间内出现急诊普外科问题的患者在7天内被确定,然后筛选脓毒症依从性(使用针对严重脓毒症设计的脓毒症六标准)和放射源控制的时机(无论是放射学还是外科手术)。探索性分析检查了模式(急诊科或全科医生)与入院时间,遵守脓毒症指南以及结局(30天内的并发症或死亡)之间的关联。结果在英国97家医院的5067名患者中,有911名(18.0%)符合败血症的标准,严重败血症为165(3·3%),败血性休克为24(0·5%)。及时交付所有脓毒症在四名患者中达到了针对严重脓毒症的六项指南。对于患有严重脓毒症的患者,在脓毒症六项中的个别指南中,有17%〜6%〜94%5%已得到实施。氧气是最有可能遗漏的标准,其次是所有败血症严重程度类别的血液培养。诊断后,源控制手术的中位数为19·8(i.q.r. 10·0–35·4)h。败血症的遗漏六个参数似乎与发病率或死亡率的增加没有关系。结论尽管败血症在急诊的普通外科患者中很常见,但大多数人对严重败血症的依从性并不完全。尽管如此,没有明显的伤害证据。

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