National Sepsis Audit 2013
Sepsis is common amongst surgical patients. A recent analysis of the American College of Surgeons National Surgical Quality Improvement Project Database found that sepsis and septic shock are ten times more common than perioperative myocardial infarction or pulmonary embolism. International evidence-based guidelines standardising the management of sepsis were developed in 2004. Application of these recommendations has been associated with a reduction in relative risk of mortality by over a third; however, whether they are implemented amongst surgical patients remains uncertain.
The aim of this audit was to ascertain adherence to international sepsis guidelines amongst acute general surgical admissions.
This was a prospective, protocol driven, multi-centre trainee led audit. Data was extracted on all patients presenting as emergencies within a seven day period. All patients meeting diagnostic criteria for sepsis, as defined by the surviving sepsis campaign, within the first 24 hours following admission were further investigated using paper and electronic records to determine adherence to the surviving sepsis guidelines.
97 hospitals in five countries participated in this audit, with 5078 patients admitted as general surgical emergencies during the study period. In total 895 (17.6%) patients (141 male, median age 67.7 years) met the diagnostic criteria for sepsis with 282 (5.6%) presenting with severe sepsis. Adherence to the Sepsis Six Bundle was poor, with less than 1% of patients receiving all six interventions within an hour. Work to correlate adherence to the guidelines with patient outcomes is currently ongoing.
The first publication from this audit is in the final stages of preparation and following this, participating collaboratives will have the opportunity to use the dataset for the purposes of further papers. Further details will be posted here as soon as they are available.