Sepsis Experience in Northwestern Puerto Rico, a case for more education
Crespo-Ramos, S.M.; Cedeño-Llorens, A.; Valle-Torres, Y.
Boletin de la Asociacion Medica de Puerto Rico 110(1): 39-44
2018
ISSN/ISBN: 0004-4849 Document Number: 703081
Sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. The Surviving Sepsis Campaign has been developing guidelines for an early diagnosis and management in septic patients. Currently, the Hospital Buen Samaritano in Aguadilla, Puerto Rico does not have a specific protocol for patients with sepsis in the ED. This study aimed to determine the incidence of sepsis, the ability of the physician to diagnose it, and the use of the severe sepsis 3-hour resuscitation bundle once the patient meets the criteria for it. A retrospective observational pilot study was done on 2 consecutive weeks between January and February 2017 to evaluate all patients above 17 years of age that assisted the ED. We used an adaptation of the screening tool of the SSC as an instrument of diagnostic measurement, and for the calculation of the time between the arrival and the development of sepsis. During this period, 1054 patients were screened and 16 (2%) met criteria for sepsis; 69% of them were diagnosed by the physician. The mean age was 68 (±13.6) years. The 30-day mortality was 25%. Lactate was ordered on 6% of the sample within the 3-hour window, and antibiotics, BC, and crystalloid fluids were ordered ³50% before diagnostic criteria for sepsis were met. It is important that all health personnel be trained on sepsis, and that primary physicians promote appropriate age vaccinations and education about symptoms that may be related to an evolving infection and the development of sepsis.
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