Characteristics and Outcomes of Clinic Visits Immediately Preceding Sepsis Hospitalization.
H Catherine Miller, Vincent X Liu, Hallie C Prescott
PMID 33644806WHAT IT FOUND
Among 118 patients hospitalized for sepsis, 10% visited a clinic within one day of admission.
Most showed abnormal vital signs or infection symptoms, yet 30% were sent home without intervention. Over half worsened before reaching the hospital, suggesting missed opportunities for earlier detection.
Key findings
0110.3% of sepsis hospitalizations were preceded by a clinic visit within one day, with 74.6% of those visits occurring on the day of admission.
0265.2% of patients had abnormal vitals or a qSOFA score of 1 or higher during their clinic visit, and 80.5% had documented symptoms of infection.
0335 patients (29.7% of the cohort) were sent home without intervention, and 52.5% of the total group experienced worsening illness severity upon ED/hospital arrival.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted at a single center, so results may not apply to other healthcare systems. Mental status and respiratory rate data were missing for many clinic visits, and assuming these were normal may have underestimated the severity of illness at the time of the clinic visit. The analysis only included patients who were ultimately hospitalized, so it does not account for patients with similar symptoms who were discharged home without sepsis.
Declared interests
The study was supported by the National Institutes of Health. No specific conflicts of interest involving commercial sponsors or author disclosures were mentioned in the text.
The easy way to misread this
Do not assume that a qSOFA score of 0 or normal vital signs in a clinic visit rules out sepsis. One-third of the patients in this study had no objective signs of illness at the clinic but were still hospitalized for sepsis shortly after.