Open AccessMulticentre observational study of adherence to Sepsis Six guidelines in emergency general surgery
Author(s) -
Natalie S Blencowe,
Sean Strong,
Jane Blazeby,
Ron Daniels,
Carol J. Peden,
Joseph Lim,
David Messenger,
H Stark,
Sarah Richards,
Chris Rogers,
Adam Trickey,
Christopher R. Carpenter,
M Fadhlillah,
W Jai,
Ramkishan Balakumar,
Renee McHugh,
Victoria Proctor,
Jonathan Wild,
Sarah Aldugman,
A Atwell,
Louise D Buchan,
N Castellimo,
Nancy Craig,
Shiva Dindyal,
F Hansell,
Anwar Ul Haque,
Stacey Magee,
J. S. Manson,
Jagadeesh Me,
H Tuckmacjy,
Frank McDermott,
Naeil Lotfi,
Piyush Sarmah,
Nicola F.D. Allen,
Nick Heywood,
Alan Rees,
A Brigic,
Adnan Ali,
James Brown,
Samriti Gupta,
David S. Hui,
Roger Lewis,
Jessamy Bagenal,
Amit Dua,
Chetan Khatri,
C Park,
John M. Bennett,
Andrew Brennan,
Oliver Pearce,
Reena Shah,
Dominique Twelves,
SL Woods,
Anna Jarvis,
Andrew A. White,
Emma Blower,
Jessica Veitch,
Gary Nicholson,
Michail Chatzikonstantinou,
Sarah Wheatstone,
Fadlo Shaban,
Adam Bartlett,
Adam Kimble,
James J. Glazier,
M Jones,
S Pengelli,
Wissam Al-Jundi,
Mohamed Sharif,
C Frizzini,
Timothy R. Wilson,
Amy M. Ashman,
Rebecca Fallaize,
Sally Hallam,
Lydia O. Simmons,
Lucinda Frank,
R Griggs,
Thomas J. Hardy,
N Lyn-White,
M Mason,
Giselle Carnaby,
J Jhah,
Laura Stuttaford,
Emma Upchurch,
Pedro Cunha,
Sarantos Kaptanis,
Salim Tayeh,
M Shamsul,
Kenneth E. Games,
Hina Iftikhar,
Muralidharan Parthasarathy,
V Bonastos,
H Taffaha,
Duncan Bew,
James Ng,
Lampros Liasis,
Yüksel Gercek,
B Moos,
JohnJoe Reilly,
Georgina Hicks,
Anuj Chawla,
Anne Miller,
Keerthi N Satheesan,
Anne Duncan,
A Vlachogiorgis,
Neel Sengupta,
Nicholas Mowbray,
Emma Barrow,
S Smith,
Daniel Fudulu,
Kencheon Hanks,
Anabelle Jones,
Angus G K McNair,
Zoe Oliphant,
Helen Weaver,
Nisha Ranga,
T Chisti,
T Imatitikua,
T.K. Jones,
Aberdeen Khan,
Ifeoluwa Ogunrinde,
Devender Mittapalli,
M Powell-Bowns,
Manoj Samuel,
Megan Wilson,
D Bilki,
D Nepdodiev,
Y Panagiotopoulou,
Constantine Halkias,
Kirsty Cattle,
C Challand,
Suresh Bandari,
Alice Chambers,
J Nguyen,
Keenan A. Walker,
M Zamurrad,
M Asarbakhsh,
M Cracium,
Y Fatine,
S Khan,
Sarah Lort,
Kay Futaba,
VS Ban,
Jingjie Cheng,
C Kambasha,
Hirah Rizki,
K Somaratne,
Andrew Wilson,
Yasser Al Omran,
Charles Anwuzia-Iwegbu,
G Yakandawala,
Colin H. Richards,
Barbara Warner,
H Graffy,
Emma MacInnes,
J.R. Nicholas,
Roxanna Zakeri,
P Barrow,
J Doran,
Louise Ewan,
L Hancock,
Jennifer Law,
H Brewer,
Ian Henderson,
Tom Palser,
James O. Murphy,
Sarah Nduwayo,
G Saggu,
Christopher R. Brown,
Elliot John Brown,
Kenneth Van Dyke,
T.R. Jeffry Evans,
M Jenkins,
John J. Lowe,
Christopher R. Brown,
R Preet,
Derek O’Reilly,
Nicholas Symons,
Hew D.T. Torrance,
Duane B. Corbett,
Mary Kelly,
T Khan,
Mohamed Ali,
Shi Sum Poon,
Peterseim Charleston,
ManrajKaur Gill,
J. Martin,
Jerry Overton,
Hema Sekhar,
Ulrich Adam,
Fayez Almari,
R Basson,
N. M. Denny,
Rachel A Khaw,
C Goatman,
Corinna Slawinski,
Richard Evans,
O Davies,
Mark Halls,
Emily J. Hotton,
Rachel Markham,
Shirley Potter,
Mitchell Foster,
I Peristakeris,
Simon Shaw,
M Marsden,
J Alshakarch,
Judith Ritchie,
Mohammed Bajalan,
C Choh,
Hazem Ahmed,
Fazal Hameed Khan,
Shahrol Yasin,
Arshad Zafar,
E Oderuth,
Andrea Sheel,
Fernando Yuenchang,
P Capozzi,
Emma Rose McGlone,
Yee Jim Loh,
Wai Cheong Soon,
Cynthia Merrifield,
Alasdair Scott,
Jihène El Kafsi,
Noel L. Warner,
Helen Mohan,
Peter Thomson,
Sara Renshaw,
David Walker,
Christopher R. Carpenter,
Doug Browning,
O Burdall,
Ken Butcher,
Annabel Greenwood,
Estelle S. Harris,
Louise Merker,
Victoria Pegna,
H Stark,
Charlotte ElSayed,
Anne Gaunt,
P Capozzi,
Katy Newton,
James Nicholson,
Lyndsay Pearce,
Christopher R. Brown,
James Brown,
Anabelle Jones,
Lucy Satherley,
Adam S. Evans,
L Lazarova,
Ann T. McAVOY,
Philip Spreadborough,
Adina Amin,
Chris Bretherton,
Andrew Chapman,
M. Fleet,
C Challand,
Zaynab Jawad,
S Al-Hallao,
Etienne N. Botha,
Pablo García,
Calum Honeyman,
Christopher Byrne,
Iqbal Kabir,
Gael R Nana,
William English,
James David Broome,
L Gilmore,
Portia Goldsmith,
Nitya Krishnamohan,
K. Matsumoto,
Kaili Ren,
C Donoso Rengifo,
Harry West,
Amy Ellison,
E Lloyd,
Duncan J. Stewart,
Amy Stimpson,
Anabelle Jones,
Greg W. Taylor,
Juliet Clutton,
Marjorie Mortimer,
Mubashir Mulla,
Alison Downey,
Michael A Houston,
K Rapson,
Niall F. Davis,
Lee Humphreys,
Jon Barnard,
Donna Egbeare,
Michael J. Whitlaw,
R. A. Zakirova
Publication year - 2017
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.10432
Subject(s) - medicine , sepsis , surviving sepsis campaign , septic shock , observational study , emergency medicine , emergency department , intensive care medicine , surgery , severe sepsis , psychiatry
Background Evidence‐based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency. Methods Patients aged 16 years or more presenting with emergency general surgery problems were identified over a 7‐day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days). Results Of a total of 5067 patients from 97 hospitals across the UK , 911 (18·0 per cent) fulfilled the criteria for sepsis, 165 (3·3 per cent) for severe sepsis and 24 (0·5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17·6–94·5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19·8 (i.q.r. 10·0–35·4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality. Conclusion Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent.