SAEM: Protocol-Driven Treatment Reduces Sepsis Mortality

May 17, 2007

CHICAGO -- A protocol for sepsis treatment in the emergency department may improve survival, researchers said here.

CHICAGO, May 17 -- A protocol for sepsis treatment in the emergency department may improve survival, researchers said here.

Early Goal-Directed Therapy (EGDT) reduced the absolute mortality rate for sepsis by 9% compared with standard treatment at the physicians' discretion, according to Alan E. Jones, M.D., of the Carolinas Medical Center, in Charlotte, N.C., and colleagues.

Dr. Jones reported his hospital's experience with the stepwise treatment algorithm at the Society for Academic Emergency Medicine meeting here.

The algorithm was first reported in clinical trial findings published in the New England Journal of Medicine in 2001. That trial had similar results. But, only about 7% of even academic center emergency departments have adopted a similar protocol, Dr. Jones said.

"The data suggests that more widespread implementation of this type of a protocol would have a substantial impact on patient outcomes," he said.

To confirm the results of the earlier trial, the researchers prospectively studied outcomes for consecutive eligible sepsis and septic shock patients treated in their emergency department in the year before and the year after implementing the protocol as standard-of-care.

Eligible patients were those with suspected infection, two or more systemic inflammatory response criteria, and either systolic blood pressure below 90 mm Hg after a fluid bolus or lactate levels above 4 Mmol.

The 77 patients treated after implementation had significantly lower systolic blood pressure (72 versus 86 mm Hg, P

The earlier trial reported a decrease in length of stay.

While the difference may not have been unexpected because patients were living longer, it warrants further investigation, Dr. Jones said.

"We are dedicating more resources to these patients," he added. "We aren't just saving their lives and they're going home in the same amount of time."

Hospitals that consider switching to protocol-driven sepsis treatment may need to consider increased length of stay in their planning so they can avoid overcrowding in the intensive care unit or hospital, he noted.

Sepsis is a common presentation in the emergency department. It is the 10th leading cause of death in the United States, and about 400,000 cases are treated in emergency departments across the nation annually.

So, the mortality benefit of protocol-driven treatment may be wide-reaching, Dr. Jones said.

"I see these patients every shift I work," he said. "I have, as a result of the protocol, seen many, many young patients that I believe have been afforded life by the protocol, who may have otherwise in previous years died."