Association of triage hypothermia with in-hospital mortality among patients in the emergency department with suspected sepsis |
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| Affiliation: | 1. Department of Neurosurgery, University Hospital Bonn, Bonn, Germany;2. Clinical Study Core Unit SZB and Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Germany;3. Clinical Study Core Unit SZB and Institute for Medical Biometry, Informatic and Epidemiology, University of Bonn, Germany;4. Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany;1. Ohio State University Wexner Medical Center, Department of Surgery, 395 W 12th Avenue, Columbus, OH, USA;2. Center for Surgical Health Assessment, Research and Policy (SHARP), Ohio State Wexner Medical Center, 395 W 12th Avenue, Columbus, OH, USA;3. Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH, USA;4. University of Wisconsin, Department of Surgery, 600 Highland Avenue, Madison, WI, USA;5. University of Massachusetts Medical School, Department of Surgery, 55 Lake Avenue, Worcester, MA, USA;1. UCLA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, USA;2. Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Australia;3. UCLA, Department of Medicine, David Geffen School of Medicine, USA;4. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, USA;5. UCLA, Department of Medicine, Quality Improvement, David Geffen School of Medicine, USA;6. UCLA, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, USA |
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| Abstract: | PurposeTo identify if triage hypothermia (<36.0 °C) among emergency department (ED) encounters with sepsis are independently associated with mortality.MethodsWe analyzed data from a multi-stage probability sample survey of visits to United States EDs between 2007 and 2015, using two inclusion approaches: an explicit definition based on diagnosis codes for sepsis and a severe sepsis definition, combining evidence of infection with organ dysfunction. We used multivariable regression to determine an association between hypothermia and in-hospital mortality.ResultsOf 1.2 billion ED encounters (95% confidence interval [CI] 1.0–1.3 billion), 3.1 million (95% CI 2.7–3.5 million) met the explicit sepsis definition; 7.4% (95% CI 75.2–9.7%) had triage hypothermia. The adjusted odds ratio (aOR) for hypothermia for in-hospital mortality was 6.82 (95% CI 3.08–15.22). The severe sepsis definition identified 3.5 million (95% 3.1–4.0 million) encounters; 30.3% (95% CI 25.0–34.6%) had triage hypothermia. The aOR for hypothermia with mortality was 4.08 (95% CI 2.09–7.95). Depending on sepsis definition, 78.1–84.4% had other systemic inflammatory response syndrome vital sign abnormalities.ConclusionUp to one in three patients with sepsis have triage hypothermia, which is independently associated with mortality. 10–20% of patients with hypothermic sepsis do not have other vital sign abnormalities. |
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