Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Sex-based differences in ED management of critically ill patients with sepsis : a nationwide cohort study

Sunden-Cullberg, Jonas ; Nilsson, Anton LU and Inghammar, Malin LU (2020) In Intensive Care Medicine 46(4). p.727-736
Abstract

Purpose: To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. Methods: We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Results: Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded—54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen—40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles... (More)

Purpose: To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. Methods: We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Results: Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded—54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen—40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p < 0.001), and shorter time to antibiotics—65 (IQR 30–136) vs 87 min (IQR 39–172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51–0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00–1.64), but the increased mortality was not mediated by differential bundle completion. Conclusions: Women and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.

(Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ED, Emergency medical services, ICU, Management, Mortality, Sepsis, Sex
in
Intensive Care Medicine
volume
46
issue
4
pages
10 pages
publisher
Springer
external identifiers
  • pmid:31974918
  • scopus:85078336663
ISSN
0342-4642
DOI
10.1007/s00134-019-05910-9
language
English
LU publication?
yes
id
b15c8172-ce19-4d73-b761-a9cddc499155
date added to LUP
2020-02-10 10:00:31
date last changed
2024-06-13 11:18:55
@article{b15c8172-ce19-4d73-b761-a9cddc499155,
  abstract     = {{<p>Purpose: To compare management and outcomes for critically ill women and men with sepsis in the emergency medical services (EMS), the emergency department (ED) and the ICU. Methods: We used two prospectively compiled Swedish national quality registers, the National Quality Sepsis Registry and the Swedish Intensive Care Registry to identify a nationwide cohort of 2720 adults admitted to an ICU within 24 h of arrival to any of 32 EDs, with a diagnosis of severe sepsis or septic shock between 2008 and 2015. Results: Patients were 44.5% female. In the EMS, a higher fraction of men had all vital signs recorded—54.4 vs 49.9% (p = 0.02) and received IV fluids and oxygen—40.0 vs 34.8% (p = 0.02). In the ED, men had completed 1-h sepsis bundles in 41.5% of cases compared to 30.0% in women (p &lt; 0.001), and shorter time to antibiotics—65 (IQR 30–136) vs 87 min (IQR 39–172) (p = 0.0001). There was no significant difference between men and women regarding ICU nursing workload, mechanical ventilation or ICU length of stay. In severity-adjusted multivariable analysis, OR for women achieving a completed sepsis bundle, compared to men was 0.64 (CI 0.51–0.81). Thirty-day mortality was 25.0% for women and 23.1% for men (p = 0.24). Adjusted OR for female death was 1.28 (CI 1.00–1.64), but the increased mortality was not mediated by differential bundle completion. Conclusions: Women and men with severe sepsis or septic shock received differential care in the ED, but this did not explain higher odds of death in women.</p>}},
  author       = {{Sunden-Cullberg, Jonas and Nilsson, Anton and Inghammar, Malin}},
  issn         = {{0342-4642}},
  keywords     = {{ED; Emergency medical services; ICU; Management; Mortality; Sepsis; Sex}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{727--736}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine}},
  title        = {{Sex-based differences in ED management of critically ill patients with sepsis : a nationwide cohort study}},
  url          = {{http://dx.doi.org/10.1007/s00134-019-05910-9}},
  doi          = {{10.1007/s00134-019-05910-9}},
  volume       = {{46}},
  year         = {{2020}},
}