National estimates of severe sepsis in United States emergency departments

Objective: The emergency department (ED) often serves as the first site for the recognition and treatment of patients with suspected severe sepsis. However, few evaluations of the national epidemiology and distribution of severe sepsis in the ED exist. We sought to determine national estimates of the number, timing, ED length of stay, and case distribution of patients presenting to the ED with suspected severe sepsis. Design: Analysis of 2001-2004 ED data from the National Hospital Ambulatory Medical Care Survey. Setting: National multistage probability sample of United States ED data. Patients: Adult (age, >= 18 yrs) patients with suspected severe sepsis, defined as the concurrent presence of an infection (ED International Classification of Diseases, 9th Revision, ICD-9) diagnosis of infection, or a triage temperature <96.8 degrees F or >= 100.4 degrees F) and organ dysfunction (ED ICD-9) diagnosis of organ dysfunction, intubation, or a triage systolic blood pressure <= 90 mm Hg). Interventions: None. Measurements: Estimated number of ED patients presenting with suspected severe sepsis, and their times of arrival, ED lengths of stay, and clinical characteristics. Main Results: Of 331.5 million adult ED visits, approximately 2.3 million (571,000 annually, 0.69%; 95% confidence interval [Cl], 0.61-0.77%) were for suspected severe sepsis. Mean ED length of stay for suspected severe sepsis was 4.7 hrs (95% Cl, 4.3-5.1 hrs), with 20.4% spending >6 hrs in the ED. Of suspected severe sepsis patients, 20.6% presented to a low-volume ED (:520,000 annual visits), 15.6% presented to ED in non-Metropolitan Statistical Areas, and 53.5% presented to EDs without medical school affiliations. More than half arrived by ambulance. Conclusions: Suspected severe sepsis patients account for more than 500,000 ED visits annually, with individual patents spending an average of almost 5 hrs in the ED. These national data offer key systemwide information for designing and implementing strategies for severe sepsis treatment.