Quality of Sepsis management and its impact on mortality at accident and emergency Kigali University Teaching Hospital (CHUK)

Abstract

Background: Sepsis is a time-sensitive medical situation requiring immediate intervention focusing on decreasing the period of time between suspected diagnosis and effective treatment. The goal of this research was to evaluate the quality of sepsis management according to the first hour bundle as proposed in the Surviving Sepsis Campaign of 2018 and its impact on patients’ inhospital mortality(1). Methods: This is a prospective cohort study design for patients who presented in sepsis condition on admission as hospital diagnosis by physicians at the emergency department of the CHUK from November 2021 until April 2022. Data were collected on patients’ demographics, site of infection, compliance with management of sepsis according to the first hour bundle (oxygen management if saturation<94%, intravenous fluid resuscitation (30ml/kg), crystalloid if SBP <90 mmHg, continuous urine monitoring, lactate levels measurement , blood sampling before antibiotics administration, and antibiotics administration within 1 hour of admission), and patients’ outcomes including mortality, length of hospital stay , requiring of mechanical ventilation, dialysis and vasopressors. RESULTS: A sum total of 385 patients over 4,742 admissions throughout the study period presented with sepsis at the emergency department of the CHUK. The median age of the subjects was 42 years (IQR 27 to 65). Most patients were male (58.2%), and lower respiratory tract was the predominant source of sepsis (55.1%). Overall, in-hospital mortality rate was 68.3 %, the median length of stay was 6 days (IQR 1 to 20). Compliance with all 6 components was not observed in any patient, compliance with a least 4 components was seen in only 14.3% cases whereas compliance with only 3 components was remarked in 58.4% of recruited patients. From the data analysis, I found that there were no significant correlation between mortality and first hour bundle compliance (OR=1.42; 95%CI: 0.74- 2.72; p =0.285). The independent predictors of mortality were age ≥65 (AOR =3.19; 95% CI: 1.486.88; p=0.003); presence of comorbidity [AOR= 3.24; 95%CI: 1.54-6.78; p=0.002]. Patients with sepsis secondary to or from community-acquired pneumonia were more likely to die than that sepsis come intra-abdominal infections [OR=0.19; 95% CI: 0.11-0.31; p<0.001]. Participants who did not receive intravenous fluid resuscitation(30ml/kg) crystalloid if SBP <90 mmHg within the first hour of admission were 3.2 times more plausibly to die than those who received intravenous fluid resuscitation (at least 30ml/kg) crystalloid if SBP <90 mmHg within first hour of admission [OR=3.26; 95%CI: 1.49-7.12; p=0.003]. Conclusion: There is a low compliance rate with the first hour bundle. There were no significant associations between mortality and first hour bundle compliance. More studies are necessary to investigate the quality of management of septic patients in more departments and hospitals in Rwanda and other Low-Income Countries (LICs)