Clinical Outcomes of Community-Acquired Severe Sepsis
after Implementation of a Simple Severe Sepsis Fast Track
Sujinda Ruangchan MD*, Sarunyou Chusri MD, PhD**, Pornthip Saengsanga MNS*,
Nongnuch Kiamkan MNS*, Pakakrong Phunpairoth MNS*, Panthip Chayakul MD**
Affiliation :
* Department of Medicine, Songkhla Hospital, Songkhla, Thailand
** Division of Infectious Disease, Department of Internal Medicine, Faculty of Medicine,
Prince of Songkla University, Songkhla, Thailand
Background : Severe sepsis and septic shock are the most common causes of in-hospital death in Songkhla Provincial
Hospital and half of the patients are transferred from community hospitals. A simple severe sepsis and septic shock fast
track had been implemented in all community hospitals in Songkhla Province and in Songkhla Provincial Hospital in
December 2013.
Objective : Evaluate the clinical outcomes and predictors of mortality of severe sepsis and septic shock patients after
implementation of the simple severe sepsis and septic shock fast track.
Material and Method: A retrospective study of all available medical records between December 2013 and May 2014 of
hospitalized patients aged older than 15 years with a final diagnosis of severe sepsis or septic shock.
Results : Of 723 patients diagnosed as community acquired sepsis, 228 (31.5%) patients were diagnosed with severe sepsis
or septic shock. A simple severe sepsis and septic shock fast track were activated in 69.3%. Patients in the activated fast
track group had significantly lower mortality than the non-activated fast track group (21.0% vs. 42.9%, p = 0.001). After
adjusted analysis, the four independent risk factors associated with increased mortality in severe sepsis and septic shock
were initial presentation with systolic blood pressure lower than 90 mmHg (adjusted odds ratio [aOR] 2.57), central nervous
system failure (aOR 7.33), acute renal failure (aOR 5.07), and received norepinephrine (aOR 2.87). Two factors associated
with a significant decrease in mortality were the simple fast track activated at the emergency department (aOR 0.22) or at
the ward (aOR 0.09) and received appropriate initial antibiotics (aOR 0.09).
Conclusion : Early recognition and early resuscitation in case of severe sepsis and septic shock can reduce mortality. A
simple severe sepsis and septic shock fast track should be implemented in all community hospitals. It is a simple clinical
diagnosis with simple management that is possible in every community hospital before transfer to a secondary or tertiary
care hospital.
Keywords : Severe sepsis, Septic shock, Death, Fast track
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