National estimates of severe sepsis in United States emergency departments

OBJECTIVE: The emergency department (ED) often serves as the first site for the recognition and treatment of patients with suspected severe sepsis. However, few evaluations of the national epidemiology and distribution of severe sepsis in the ED exist. We sought to determine national estimates of the number, timing, ED length of stay, and case distribution of patients presenting to the ED with suspected severe sepsis. DESIGN: Analysis of 2001-2004 ED data from the National Hospital Ambulatory Medical Care Survey. SETTING: National multistage probability sample of United States ED data. PATIENTS: Adult (age, >or=18 yrs) patients with suspected severe sepsis, defined as the concurrent presence of an infec-tion (ED International Classification of Diseases, 9th Revision; ICD-9) diagnosis of infection, or a triage temperature <96.8 degrees F or >or=100.4 degrees F) and organ dysfunction (ED ICD-9) diagnosis of organ dysfunction, intubation, or a triage systolic blood pressure 6 hrs in the ED. Of suspected severe sepsis patients, 20.6% presented to a low-volume ED (