Impact of time of intensive care unit transfer and outcomes in patients with septic shock: An observational study.
emergency department
intensive care unit
length of stay
mortality
septic shock
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
revised:
22
12
2022
received:
13
09
2022
accepted:
29
12
2022
medline:
18
7
2023
pubmed:
1
2
2023
entrez:
31
1
2023
Statut:
ppublish
Résumé
To evaluate the association between time from ED presentation to intensive care unit (ICU) transfer on mortality in patients presenting with septic shock. Adult patients with suspected septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation trial were included. The primary outcome of this post-hoc analysis was 90-day mortality. ED-to-ICU time was analysed as both a continuous variable and a binary variable (≤ vs >4 h). Analysis incorporated mixed effects regression, with ICU site as a random effect, time-to-event analysis and competing risks regression; all with and without inverse probability of treatment weighting to account for confounding baseline covariates. Data from 1301 patients were included. Median (interquartile range [IQR]) ED-to-ICU time was 4.3 (3.1, 6.3) hours, with 588 patients (45%) transferred within 4 h. The ≤4-h group were younger, 64 (51, 74) versus 67 (52, 76) years (P = 0.04), with higher APACHE III scores, 50 (37, 65) versus 47 (35, 62) (P = 0.002), and higher unadjusted 90-day mortality, odds ratio (OR) 1.53 (95% confidence interval 1.15, 2.03), P = 0.01. After adjustment for pre-specified confounders, the 90-day mortality OR was 1.09 (0.83, 1.44), P = 0.52. Adjusted for death as a competing event and illness severity, hospital length of stay was similar between groups, whereas ICU duration remained longer for the ≤4-h group. In patients presenting to the ED with septic shock, ED-to-ICU time less than 4 h was not associated with altered 90-day mortality, although this should be interpreted with caution due to study limitations.
Identifiants
pubmed: 36718053
doi: 10.1111/1742-6723.14175
doi:
Types de publication
Observational Study
Journal Article
Comment
Langues
eng
Sous-ensembles de citation
IM
Pagination
612-617Commentaires et corrections
Type : CommentOn
Informations de copyright
© 2023 Australasian College for Emergency Medicine.
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