ArticleAcademic emergency medicine : official journal of the Society for Academic Emergency Medicine2021
Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge.
Article in Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review.Annals of internal medicine · 2025Pooled it
- Development of a machine learning-based sepsis prediction model for real-world clinical settings in South Korea: a single-center retrospective study.Journal of Korean biological nursing science · 2026Article
- Cell population data for early detection of sepsis in patients with suspected infection in the emergency department.Clinical chemistry and laboratory medicine · 2025Article
- Mortality and antibiotic timing in deep learning-derived surviving sepsis campaign risk groups: a multicenter study.Critical care (London, England) · 2025Observational
- Diagnostic safety and quality optimization in sepsis study protocol.Journal of hospital medicine · 2025Article
- Factors and outcomes associated with under- and overdiagnosis of sepsis in the first hour of emergency department care.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025Observational
- Evaluating the impact of common clinical confounders on performance of deep-learning-based sepsis risk assessment.Frontiers in artificial intelligence · 2025Article
- Observational
- Clinical impact of the implementation of monocyte distribution width (MDW) measurement on time to anti-infective administration in sepsis patients in the emergency department: a before/after cohort study.Critical care (London, England) · 2024Article
- The pathophysiology of sepsis and precision-medicine-based immunotherapy.Nature immunology · 2024Review
- 30 Days Mortality Prognostic Value of POCT Bio-Adrenomedullin and Proenkephalin in Patients with Sepsis in the Emergency Department.Medicina (Kaunas, Lithuania) · 2022Observational
- Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department.BMC infectious diseases · 2022Observational
- Varying Estimates of Sepsis among Adults Presenting to US Emergency Departments: Estimates from a National Dataset from 2002-2018.Journal of intensive care medicine · 2022Article
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5 authors.
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Abstract
objectivesEffective sepsis resuscitation depends on useful criteria for prompt identification of eligible patients. These criteria should reliably predict a discharge diagnosis of sepsis, ensuring that interventions are triggered for those who need it while avoiding potentially harmful interventions in those who do not. We sought to determine the proportion of patients meeting sepsis criteria in the emergency department (ED) that was ultimately diagnosed with sepsis and to quantify the subset of nonseptic patients with risk factors for harm from fluid resuscitation.
methodsThis retrospective cohort study of adult ED patients at a tertiary academic medical center included vital signs and laboratory results from the first 6 hours, plus administration of intravenous antibiotics, to determine if patients met 2016 Sepsis-3 consensus criteria. If these patients also had hypotension and lactic acidosis, we categorized them as Sepsis-3 plus shock. We used discharge ICD-9 codes to determine if patients were ultimately diagnosed with sepsis.
resultsOver 8 years, 3,121 ED patients met 2016 Sepsis-3 criteria in the first 6 hours. Of these, only 25% and 48% met explicit and implicit criteria for a discharge diagnosis of sepsis. Of 1,032 patients with Sepsis-3 plus shock, 48% and 62% met explicit and implicit criteria. Overall, 60% to 75% of ED patients meeting Sepsis-3 criteria with or without shock did not receive a sepsis discharge diagnosis. At least one plausible risk factor for harm from large-volume fluid resuscitation was identified among 19% to 36% of patients meeting sepsis criteria in the ED but not ultimately diagnosed with sepsis at discharge.
conclusionsMost patients meeting sepsis criteria in the ED were not diagnosed with sepsis at discharge. Urgent treatment bundles triggered by consensus criteria in the early phase of ED care may be administered to several patients without sepsis, potentially exposing some to interventions of uncertain benefit and possible harm.
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