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KMID : 0385920180290050465
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Journal of the Korean Society of Emergency Medicine
2018 Volume.29 No. 5 p.465 ~ p.473
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Characteristics and outcomes of patients with septic shock who transferred to the emergency department in tertiary referral center: multicenter, retrospective, observational study
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Kim Min-Gyun
Shin Tae-Gun
Jo Ik-Joon
Kim Won-Young
Ryoo Seung-Mok
Chung Sung-Phil
Beom Jin-Ho
Choi Sung-Hyuk
Kim Kyu-Seok
Jo You-Hwan
Kang Gu-Hyun
Suh Gil-Jun
Shin Jong-Hwan
Lim Tae-Ho
Han Gap-Su
Hwang Sung-Yeon
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Abstract
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Objective: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center.
Method: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality.
Results: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999) for the transferred group compared with the non-transferred group.
Conclusion: The transferred group showed higher severity and needed more organ support procedures than the nontransferred group. However, inter-hospital transfer did not affect in-hospital mortality.
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KEYWORD
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Sepsis, Septic shock, Mortality, Interhospital transfer
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