ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2019
Variation in Emergency Department Adherence to Treatment Guidelines for Inpatient Pneumonia and Sepsis: A Retrospective Cohort Study.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 12 citations in OpenAlex.
- Impact of online patient access to clinical notes on quality of care: a systematic review.BMJ quality & safety · 2026Pooled it
- Implementation Science for Emergency Physicians: A Schematic Diagram and Step-By-Step Guidance to Implement Evidence-Based Innovations.Journal of the American College of Emergency Physicians open · 2026Review
- Diagnostic and prognostic value of LINC00278 in patients with severe pneumonia and its regulatory role.Journal of inflammation (London, England) · 2026Article
- Microbiological findings and antibiotic treatment in community-acquired pneumonia: a retrospective cohort study.BMC infectious diseases · 2026Article
- User-Centered Redesign of a Clinical Decision Support System for Pneumonia in the Emergency Department.Applied clinical informatics · 2026Article
- Order Set Usage is Associated With Lower Hospital Mortality in Patients With Sepsis.Critical care explorations · 2023Article
- Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Observational
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesEvidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence.
methodsThis was a multicenter retrospective study using standard medical record review methods. The population consisted of consecutive adults hospitalized for pneumonia or sepsis (identified by discharge ICD-9 codes) at five Colorado hospitals (two academic, three community) who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. The outcome measured was ED adherence to the CPG (primary) and in-hospital mortality (secondary). Hierarchical generalized linear models were used for analysis.
resultsAmong 827 patients, ED care was 57% adherence to CPGs with significant variation in adherence across CPGs (sepsis 50%, pneumonia 64%, p < 0.001). Patients were less likely to receive adherent care if they presented with chief complaints that were associated but not typical of the diagnosis (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4-0.8), received an ED diagnosis that was not specific to the CPG (associated diagnosis OR = 0.3 [95% CI = 0.2-0.5]; unrelated diagnosis OR = 0.4 [95% CI = 0.2-0.6]) or presented to a community hospital (OR = 0.6, 95% CI = 0.4-0.9). ED CPG nonadherence was associated with higher in-hospital mortality (OR = 2.4, 95% CI = 1.2-4.8).
conclusionAdherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in-hospital mortality.
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