Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

BMJ Open - Tập 8 Số 9 - Trang e022832 - 2018
Feike J Loots1,2,3, Marleen Smits3, Carlijn van Steensel3, Paul Giesen3, Rogier Hopstaken4,5, Arthur R. H. van Zanten6
1Emergency Department, Gelderse Vallei Hospital, Ede, The Netherlands
2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
3Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, The Netherlands
4Department of General Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
5STAR-SHL, Etten-Leur, The Netherlands
6Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands

Tóm tắt

ObjectivesTimely recognition and treatment of sepsis is essential to reduce mortality and morbidity. Acutely ill patients often consult a general practitioner (GP) as the first healthcare provider. During out-of-hours, GP cooperatives deliver this care in the Netherlands. The aim of this study is to explore the role of these GP cooperatives in the care for patients with sepsis.DesignRetrospective study of patient records from both the hospital and the GP cooperative.SettingAn intensive care unit (ICU) of a general hospital in the Netherlands, and the colocated GP cooperative serving 260 000 inhabitants.ParticipantsWe used data from 263 patients who were admitted to the ICU due to community-acquired sepsis between January 2011 and December 2015.Main outcome measuresContact with the GP cooperative within 72 hours prior to hospital admission, type of contact, delay from the contact until hospital arrival, GP diagnosis, initial vital signs and laboratory values, and hospital mortality.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.7 hours. The GP had not suspected an infection in 43% of the patients. In this group, the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% vs 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in prehospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.

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Tài liệu tham khảo

10.1001/jama.2016.0287

10.1056/NEJMra1208623

10.1001/jama.2010.1553

Bakker, 2004, [Sepsis, a complicated syndrome with major medical and social consequences], Ned Tijdschr Geneeskd, 148, 975

Tsertsvadze, 2016, Community-onset sepsis and its public health burden: a systematic review, Syst Rev, 5, 81, 10.1186/s13643-016-0243-3

10.1097/00003246-200107000-00002

10.1097/CCM.0b013e31827c09f8

Bijkerk, 2010, [Effects of ageing on infectious disease], Ned Tijdschr Geneeskd, 154, A1613

10.1007/s00134-017-4683-6

Tromp, 2011, The effects of implementation of the surviving sepsis campaign in the Netherlands, Neth J Med, 69, 292

10.3109/10903127.2015.1037476

10.1097/MEJ.0000000000000302

Loots FJ , Arpots R , vd BR , et al . Recognition of sepsis in primary care: a questionnaire survey among general practitioners. BJGP Open 2017.

Smits, 2017, The development and performance of after-hours primary care in the Netherlands: a narrative review, Ann Intern Med, 166, 737, 10.7326/M16-2776

InEen. Benchmark bulletin Huisartsenposten 2016 [Benchmark report primary care physician cooperatives 2016] Utrecht, The Netherland: InEen. 2017 https://ineen.nl/assets/files/assets/uploads/170824_Benchmarkbulletin_2016_Huisartsenposten.pdf (accessed 20 Oct 2017).

10.1378/chest.101.6.1644

Sundén-Cullberg, 2017, fever in the emergency department predicts survival of patients with severe sepsis and septic shock admitted to the ICU, Crit Care Med, 45, 591, 10.1097/CCM.0000000000002249

10.1016/S0140-6736(06)67932-4

NICE guidelines [NG51]. Sepsis: recognition, diagnosis and early management. 2016 https://www.nice.org.uk/guidance/ng51 (accessed 20 Oct 2017).

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BMJ Open

Tập 8 Số 9

e022832

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