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Saengsanga P ,
Kiamkan N ,
Phunpairoth P ,
Chayakul P Objective: Evaluate the clinical outcomes and predictors of mortality of severe sepsis and septic shock patients after implementation of the simple severe sepsis and septic shock fast track.
Material and Method: A retrospective study of all available medical records between December 2013 and May 2014 of hospitalized patients aged older than 15 years with a final diagnosis of severe sepsis or septic shock.
Results: Of 723 patients diagnosed as community acquired sepsis, 228 (31.5%) patients were diagnosed with severe sepsis or septic shock. A simple severe sepsis and septic shock fast track were activated in 69.3%. Patients in the activated fast track group had significantly lower mortality than the non-activated fast track group (21.0% vs. 42.9%, p = 0.001). After adjusted analysis, the four independent risk factors associated with increased mortality in severe sepsis and septic shock were initial presentation with systolic blood pressure lower than 90 mmHg (adjusted odds ratio [aOR] 2.57), central nervous system failure (aOR 7.33), acute renal failure (aOR 5.07), and received norepinephrine (aOR 2.87). Two factors associated with a significant decrease in mortality were the simple fast track activated at the emergency department (aOR 0.22) or at the ward (aOR 0.09) and received appropriate initial antibiotics (aOR 0.09).
Conclusion: Early recognition and early resuscitation in case of severe sepsis and septic shock can reduce mortality. A simple severe sepsis and septic shock fast track should be implemented in all community hospitals. It is a simple clinical diagnosis with simple management that is possible in every community hospital before transfer to a secondary or tertiary care hospital.
Keywords: Severe sepsis, Septic shock, Death, Fast track