The incidence and impact of sepsis with regard to hospital mortality is largely misunderstood. We view initial acuity of both septic and non-septic patients using a general, validated measure of physiological condition, the Rothman Index. Although septic patients do arrive at the hospital in poorer physiological condition than non-septic patients, the initial acuity profile of sepsis patients who expire looks almost identical to that of non-sepsis patients who expire. Quantitatively, a logistic regression model yields an AUC for mortality using only initial RI, of 0.907, using initial RI and a POA sepsis indicator, it is 0.909. The implication is that quality improvement efforts would be better focused not on determining who has sepsis, but rather on addressing any patient who arrives at the hospital in poor physiological condition.
Learning Objective: Understand the significance of initial physiological condition on arrival at the hospital with regard to sepsis and sepsis mortality.
Michael Rothman (Presenter)
Kathy Belk, PeraHealth
Robert Fogerty, Yale New Haven Hospital