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Disparities in the Care of Patients with Sepsis
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A6003 - Disparities in the Care of Patients with Sepsis
Author Block: C. Rabascall Ayoub1, J. Rey-Mendoza1, W. Kowacz1, S. J. Quinn2, A. Kaye2, V. Esmero2, A. Tulaimat3, J. A. Greenberg2, R. Gueret3; 1Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States, 2Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, United States, 3Pulmonary, Critical Care and Sleep Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States.
INTRODUCTION:
Studies have shown potential inequities in the care of patients with sepsis based on gender, race and socioeconomic status. The objective of our study was to investigate the possible disparities in care provided to our patients.
METHODS:
We conducted a retrospective review of adult patients with sepsis admitted over a period of two years from the emergency department to the intensive care unit at two hospitals in Chicago (university and community hospitals). Patients were identified using a validated ICD-9 search strategy and manually reviewed for inclusion of Sepsis-3 criteria. Cases were the patients that died during the hospitalization. Controls were time-matched to deceased patient in a 1:1 ratio. Basic demographic characteristics, insurance status, household income were collected. Statistical analysis was performed using MedCalc®.
RESULTS:
198 patients were included, 52% were males, 93 patients were from the community hospital. Patients from the community hospital were younger, had a higher initial SOFA score and were more likely to be uninsured.
Administration of antibiotics within 3 hours of sepsis diagnosis occurred in 55%, obtaining blood cultures in 62%, and lactate measurement in 70%. This resulted in a 37% compliance with all the three bundles. Overall compliance did not differ between the private and public hospital or type of insurance. Patient’s gender did not affect the time to antibiotic administration, time to blood cultures collection, and overall bundle compliance. Three-hour bundle compliance did not affect chance of survival.
Logistic regression analysis showed that a SOFA score less than seven (OR: 3.8, 95% CI 1.9-7.7) and a low lactate level (OR: 0.86, 95% CI 0.76-0.97) were associated with survival. Race, age, socioeconomic or insurance status or type of hospital did not affect survival.
CONCLUSIONS:
We did not find disparities in the care of patients with the diagnosis of sepsis based on age, gender, race, insurance or socioeconomic status. Interestingly, compliance with any of the bundle elements or all three components of the bundle did not affect survival. The physiologic parameters were the only predictors of outcome.
Author Block: C. Rabascall Ayoub1, J. Rey-Mendoza1, W. Kowacz1, S. J. Quinn2, A. Kaye2, V. Esmero2, A. Tulaimat3, J. A. Greenberg2, R. Gueret3; 1Internal Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States, 2Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL, United States, 3Pulmonary, Critical Care and Sleep Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, United States.
INTRODUCTION:
Studies have shown potential inequities in the care of patients with sepsis based on gender, race and socioeconomic status. The objective of our study was to investigate the possible disparities in care provided to our patients.
METHODS:
We conducted a retrospective review of adult patients with sepsis admitted over a period of two years from the emergency department to the intensive care unit at two hospitals in Chicago (university and community hospitals). Patients were identified using a validated ICD-9 search strategy and manually reviewed for inclusion of Sepsis-3 criteria. Cases were the patients that died during the hospitalization. Controls were time-matched to deceased patient in a 1:1 ratio. Basic demographic characteristics, insurance status, household income were collected. Statistical analysis was performed using MedCalc®.
RESULTS:
198 patients were included, 52% were males, 93 patients were from the community hospital. Patients from the community hospital were younger, had a higher initial SOFA score and were more likely to be uninsured.
Administration of antibiotics within 3 hours of sepsis diagnosis occurred in 55%, obtaining blood cultures in 62%, and lactate measurement in 70%. This resulted in a 37% compliance with all the three bundles. Overall compliance did not differ between the private and public hospital or type of insurance. Patient’s gender did not affect the time to antibiotic administration, time to blood cultures collection, and overall bundle compliance. Three-hour bundle compliance did not affect chance of survival.
Logistic regression analysis showed that a SOFA score less than seven (OR: 3.8, 95% CI 1.9-7.7) and a low lactate level (OR: 0.86, 95% CI 0.76-0.97) were associated with survival. Race, age, socioeconomic or insurance status or type of hospital did not affect survival.
CONCLUSIONS:
We did not find disparities in the care of patients with the diagnosis of sepsis based on age, gender, race, insurance or socioeconomic status. Interestingly, compliance with any of the bundle elements or all three components of the bundle did not affect survival. The physiologic parameters were the only predictors of outcome.
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