TY - JOUR
T1 - Effectiveness of a sepsis programme in a resource-limited setting: A retrospective analysis of data of a prospective observational study (Ubon-sepsis)
AU - Booraphun, Suchart
AU - Hantrakun, Viriya
AU - Siriboon, Suwatthiya
AU - Boonsri, Chaiyaporn
AU - Poomthong, Pulyamon
AU - Singkaew, Bung-Orn
AU - Wasombat, Oratai
AU - Chamnan, Parinya
AU - Champunot, Ratapum
AU - Rudd, Kristina
AU - Day, Nicholas P. J.
AU - Dondorp, Arjen M.
AU - Teparrukkul, Prapit
AU - West, Timothy Eoin
AU - Limmathurotsakul, D. Irek
N1 - Funding Information: Funding The study was funded by the Wellcome Trust (090219/Z/09/Z) and National Heart, Lung and Blood Institute, National Institutes of Health (R01HL113382). DL is supported by an intermediate fellowship from the Wellcome Trust (101103/Z/13/Z). Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/2/18
Y1 - 2021/2/18
N2 - Objective To evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015. Design A retrospective analysis using the data of a prospective observational study (Ubon-sepsis) from March 2013 to January 2017. Setting General medical wards and medical intensive care units (ICUs) of a study hospital. Participants Patients with community-acquired sepsis observed under the Ubon-sepsis cohort. Sepsis was defined as modified Sequential Organ Failure Assessment (SOFA) Score ≥2. Main exposure The SFT programme was a protocol to identify and initiate sepsis care on hospital admission, implemented at the study hospital in 2015. Patients in the SFT programme were admitted directly to the ICUs when available. The non-exposed group comprised of patients who received standard of care. Main outcome The primary outcome was 28-day mortality. The secondary outcomes were measured sepsis management interventions. Results Of 3806 sepsis patients, 903 (24%) were detected and enrolled in the SFT programme of the study hospital (SFT group) and 2903 received standard of care (non-exposed group). Patients in the SFT group had more organ dysfunction, were more likely to receive measured sepsis management and to be admitted directly to the ICU (19% vs 4%). Patients in the SFT group were more likely to survive (adjusted HR 0.72, 95% CI 0.58 to 0.88, p=0.001) adjusted for admission year, gender, age, comorbidities, modified SOFA Score and direct admission to the ICUs. Conclusions The SFT programme is associated with improved sepsis care and lower risk of death in sepsis patients in rural Thailand, where some critical care resources are limited. The survival benefit is observed even when all patients enrolled in the programme could not be admitted directly into the ICUs. Trial registration number NCT02217592.
AB - Objective To evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015. Design A retrospective analysis using the data of a prospective observational study (Ubon-sepsis) from March 2013 to January 2017. Setting General medical wards and medical intensive care units (ICUs) of a study hospital. Participants Patients with community-acquired sepsis observed under the Ubon-sepsis cohort. Sepsis was defined as modified Sequential Organ Failure Assessment (SOFA) Score ≥2. Main exposure The SFT programme was a protocol to identify and initiate sepsis care on hospital admission, implemented at the study hospital in 2015. Patients in the SFT programme were admitted directly to the ICUs when available. The non-exposed group comprised of patients who received standard of care. Main outcome The primary outcome was 28-day mortality. The secondary outcomes were measured sepsis management interventions. Results Of 3806 sepsis patients, 903 (24%) were detected and enrolled in the SFT programme of the study hospital (SFT group) and 2903 received standard of care (non-exposed group). Patients in the SFT group had more organ dysfunction, were more likely to receive measured sepsis management and to be admitted directly to the ICU (19% vs 4%). Patients in the SFT group were more likely to survive (adjusted HR 0.72, 95% CI 0.58 to 0.88, p=0.001) adjusted for admission year, gender, age, comorbidities, modified SOFA Score and direct admission to the ICUs. Conclusions The SFT programme is associated with improved sepsis care and lower risk of death in sepsis patients in rural Thailand, where some critical care resources are limited. The survival benefit is observed even when all patients enrolled in the programme could not be admitted directly into the ICUs. Trial registration number NCT02217592.
KW - epidemiology
KW - infectious diseases
KW - intensive & critical care
UR - http://www.scopus.com/inward/record.url?scp=85101299066&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjopen-2020-041022
DO - https://doi.org/10.1136/bmjopen-2020-041022
M3 - Article
C2 - 33602702
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 2
M1 - 041022
ER -