J Korean Soc Emerg Med.  2018 Oct;29(5):465-473. 10.0000/jksem.2018.29.5.465.

Characteristics and outcomes of patients with septic shock who transferred to the emergency department in tertiary referral center: multicenter, retrospective, observational study

• Kim MG
• Shin TG
• Jo IJ
• Kim WY
• Ryoo SM
• Chung SP
• Beom JH
• Choi SH
• Kim K
• Jo YH
• Kang GH
• Suh GJ
• Shin J
• Lim TH
• Han KS
• Hwang SY
• for the Korean Shock Society (KoSS) Investigators

• KMID: 2435471
• DOI: http://doi.org/10.0000/jksem.2018.29.5.465

Abstract

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.
METHODS
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.

Keyword

Sepsis; Septic shock; Mortality; Interhospital transfer

MeSH Terms

Emergencies*
Emergency Service, Hospital*
Hospital Mortality
Humans
Logistic Models
Mortality
Observational Study*
Odds Ratio
Prognosis
Prospective Studies
Renal Replacement Therapy
Retrospective Studies*
Sepsis
Shock
Shock, Septic*
Tertiary Care Centers*
Ventilators, Mechanical