Factors Predicting Severity of Physiological Deterioration among Sepsis Patients in Emergency Department
Keywords:
age, comorbidity, ADL ability, physiological deterioration severity, sepsis patientsAbstract
Objective: To study factors predicting the severity of physiological deterioration among sepsis patients treated in an emergency department
Design: Predictive correlational design
Methodology: The sample was 189 sepsis patients classified into levels 1 to 3 according to Healthcare Region 4’s triage system and treated in the emergency department of a tertiary hospital. The data collection instruments consisted of a demographic questionnaire, Charlson’s Comorbidity Index (CCI), Barthel Index (BI), and the National Early Warning Score (NEWS2).The predictive power was analysed using the enter-method multiple regression coefficient, with the significance level set at .05.
Results: Of the sepsis patients included in this study, 54% were female, 50.8% were aged between 65-85 years (average 68.35, SD = 14.94), and 83.6% had perceived their symptoms for 24 hours or more. The majority of the patients (74.1%) needed immediate assistance at triage level 1. About half (49.21%) of the sepsis cases involved the respiratory system, with highly severe physiological deterioration detected in as many as 82.5%. A predictive analysis revealed that the age of ≥ 65, comorbidities, and ADL performance were
jointly capable of predicting 13.5% (p < .05) of physiological deterioration severity.
Recommendations: Nurses should conduct thorough assessment of sepsis patients’ ages, comorbidities, ADL ability, and physiological deterioration severity in the triage process, to ensure prompt and appropriate treatment for the patients in accord with the healthcare service development plan
References
Fleischmann C, Scherag A, Adhikar NKJ, Christiane SH, Tsaganos T, Schlattmann P, et al. Assessment of
global incidence and mortality of hospital-treated sepsis. Am J Respir Crit Care Med [Internet]. 2016 [cited 2019 Sep 18];193(3):257-72. doi: 10. 1164/rccm.201504-0781OC.
Ministry of Public Health. Ministry of Public Health inspection plan for 2019. [Internet]. [Cited 2019 Ang 20]. Available from: http://bie.moph.go.th/ e-insreport_ex/ (in Thai)
Wang HE, Jones AR, Donnelly JP. Revised national estimates of emergency department visits for sepsis
in the United States. Crit Care Med [Internet]. 2017 [cited 2019 Sep 18];45(9):1443-9. doi: 10.
/CCM.0000000000002538.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international
consensus definitions for sepsis and septic shock (sepsis-3) consensus definitions for sepsis and septic shock. JAMA [Internet]. 2016 [cited 2019 Sep 18]; 315(8):801-10. doi: 10.1001/jama.2016.0287.
Steinhagen F, Schmidt SV, Schewe JC, Peukert K, Klinman DM, Bode C. Immunotherapy in sepsis - brake
or accelerate. Pharmacol Ther [Internet]. 2020 [cited 2021 Apr 1]; 2020;208:107476. doi: 10.1016/j.
pharmthera.2020.107476.
Bunyaphatkun P, Sindhu S, Davidson PM, Utriyaprasit K. Viwatwongkasem C, Chartbunchachai W. Factors
influencing clinical deterioration in persons with sepsis. PRIJNR [Internet]. 2017 [cited 2019 Sep 18]; 21(2):135-47. Available from: https://he02.tcithaijo. org/index.php/PRIJNR/article/view/71287 (in Thai)
Quinten VM, van Meurs M, Olgers TJ, Vonk JM, Ligtenberg JJM, ter Maaten JC. Repeated vital sign measurements in the emergency department predict patient deterioration within 72 hours: a prospective
observational study. Scand J Trauma Resusc Emerg Med [Internet]. 2018 [cited 2019 Sep 20];26(1): 57-69. doi: org/10.1186/s13049-018-0525-y.
Royal College of Physicians. National Early Warning Score (NEWS) 2: standardising the assessment of acute-illness severity in the NHS. Updated report of a working party [Internet]. London: RCP, 2017 [cited 2020 Jul 16]. 15 p. Available from: https://www.rcplondon.ac.uk/projects/outputs/national-earlywarning-score-news-29. Kim I, Song H, Kim HJ, Park KN, Kim SH, Oh SH, et al. Use of the national early warning score for predicting in-hospital mortality in older adults admitted to the emergency department. Clin Exp Emerg Med [Internet]. 2020 [cited 2020 Jul 16];7(1):61-6. doi: 10.15441/ceem.19.036.
Wester AL, Dunlop O, Melby KK, Dahle UR, Wyller TB. Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis [Internet]. 2013 [cited 2019 Sep 26];13(1):346-58. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-346
Valencia AM, Vallejo CE, Alvarez ALL, Jaimes FA. Attenuation of the physiological response to infection on adults over 65 years old admitted to the emergency room (ER). Aging Clin Exp Res [Internet]. 2017 [cited 2019 Sep 20];29(5):847-56. doi: 10.1007/ s40520-016-0679-2.
Oltean S, Tatulescu D, Bondor C, Slavcovici A, Cismaru C, Lupse M, et al. Charlson’s weighted index of comorbidities is useful in assessing the risk of death in septic patients. J Crit Care [Internet]. 2012 [cited 2019 Aug 26];27(4):370-5. doi: 10.1016/j.jcrc.2011.08.021.
Bahrmann A, Benner L, Christ M, Bertsch T, Sieber CC, Katus H, et al. The Charlson Comorbidity and
Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in
unselected older patients admitted to the emergency department. Aging Clin Exp Res [Internet]. 2019 [cited 2019 Sep 30];31:1233-42. doi: 10.1007/ s40520-018-1067-x.
Shibahashi K, Sugiyama K, Kashiura M, Hamabe Y. Decreasing skeletal muscle as a risk factor for mortality
in elderly patients with sepsis: a retrospective cohort study. J Intensive Care [Internet]. 2017 [cited 2020 Jul
;5:1-8. doi: 10.1186/s40560-016-0205-9.
Wilson D, Jackson T, Sapey E, Lord JM. Frailty and sarcopenia: the potential role of an aged immune system. Ageing Res Rev [Internet]. 2017 [cited 2020 Jul 20];36:1-10.doi: 10.1016/j.arr.2017.01.006.
Julian-Jimenez A, Gonzalez-del-Castillo J, Martinez-Ortiz-de-Zarate M, Arranz-Nieto MJ, Gonzalez-Martinez
F, Pinera-Salmeron P, et al. Short-term prognostic factors in the elderly patients seen in emergency departments
due to infections. Enferm Infecc Microbiol Clin [Internet]. 2017 [cited 2019 Sep 20];35(4):214-9. doi: 10. 1016/ j.eimc.2015.10.016.
Capp R, Horton CL, Takhar SS, Ginde AA, Peak DA, Zane R, et al. Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency
department arrival. Crit Care Med [Internet]. 2015 [cited 2019 Aug31];43(5):983-8. doi: 10.1097/ ccm.0000000000000861.
Lee SY, Kim JJ, Jamg JH, Hwang IC. Prognostic factors in septic shock patients on arrival at emergency
department. Ann Geriatr Med Res [Internet]. 2017 [cited 2019 Aug 16];21(4):168-73. doi: https://doi.org/10.4235/agmr.2017.21.4.168.
Caraballo C, Ascuntar J, Hincapie C, Restrepo C, Bernal E, Jaimes F. Association between site of infection and
in-hospital mortality in patients with sepsis admitted to emergency departments of tertiary hospitals in
Medellin, Colombia. Rev Bras Ter Intensiva [Internet]. 2019 [cited 2020 Oct 26];31(1):47-56. doi: 10. 5935/0103-507X.20190011.
Rollandi GA, Chiesa A, Sacchi N, Castagnetta M, Puntoni M, Amaro A, et al. Biological age versus chronological age in the prevention of age associated diseases. OBM Geriat [Internet]. 2019 [cited 2020 Oct 20];3(2):1-14. doi:10.21926/obm.geriatr.1902051.
Sivan S, Viswasom AA, B K. Age changes in the thymus a histological and morrphological study. J Evol Med
Dent Sci [Internet]. 2013 [cited 2019 Sep 20];2: 2767-75. doi:10.14260/JEMDS/615. 22. Lysenko L, Lesnik P, Nelke K, Gerber H. Immune disorders in sepsis and their treatment as a significant problem of modern intensive care. Postepy Hig Med Dosw [Internet]. 2017 [cited 2021 Jan 2];71(1): 703-12. doi: 10.5604/01.3001.0010.3849.
Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index: A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J [Internet]. 1965 [cited 2019 Aug 21];14:61-5. Available from: https://www.semanticscholar.org/paper/Functionalevaluation-%3B-the-Barthel-index.-A-simpleMahoney-Barthel/c71fe40c867d 7e7046e2b655cf70e12eedaac8b3
Sinapidis D, Kosmas V, Vittoros V, Koutelidakis IM, Pantazi A, Stefos A, et al. Progression into sepsis: an
individualized process varying by the interaction of comorbidities with the underlying infection. BMC Infect Dis [Internet]. 2018 [cited 2020 Dec 3];18: 242-51. Available from: https://bmcinfectdis.
biomedcentral.com/articles/10.1186/s12879-018-3156-z
Xu J, Tong L, Yao J, Guo Z, Lui K Y, Hu X, Cao L,et al. Association of sex with clinical outcome in critically
ill sepsis patients: a retrospective analysis of the large clinical database MIMIC-III. The Shock Society. [Internet] 2019 [cited 2020 Nov 30];52(2):146-151. doi: 10.1097/SHK.0000000000001253.
Mellhammar L, Christensson B, Linder A. Public Awareness of Sepsis Is Low in Sweden. Open Forum Infect Dis [Internet]. 2015 [cited 2020 Nov 30]; 2(4):161-5. doi: 10.1093/ofid/ofv161
Lee GT, Hwang SY, Jo IJ, Kim TR, Yoon H, Park JH, et al. Associations between mean arterial pressure and
-day mortality according to the presence of hypertension or previous blood pressure level in critically ill sepsis
patients. J Thorac Dis. 2019;11(5):1980-8. doi: 10.21037/jtd.2019.04.108.
Jongprasitkul N, Petchratchatanon W, Charanyananda C. Association between clinical parameters and risk
of sepsis. Chula Med J [Internet]. 2018 [cited 2021 Apr 30];62(1): 29-38. Available from: http://clmjournal.org/_fileupload/journal/327-2-3.pdf. (in Thai).
Shiao CC, Hsu HC, Chen IL, Weng CY, Chuang JC, Lin SC, et al. Lower Barthel Index is associated with higher risk of hospitalization-requiring pneumonia in long-term care facilities. Tohoku J Exp Med [Internet]. 2015 [cited 2020 Dec 3];236(4):281-8. doi: 10. 1620/tjem.236.281
