Abstract:
We aimed to assess the prevalence, patient allocation adequacy, and mortality of adults with sepsis in Brazilian emergency
departments (ED) in a point-prevalence 3-day investigation of patients with sepsis who presented to the ED and those who
remained there due to inadequate allocation. Allocation was considered adequate if the patient was transferred to the intensive care unit (ICU), ward, or remained in the ED without ICU admission requests. Prevalence was estimated using the total
ED visit number. Prognostic factors were assessed with logistic regression. Of 33,902 ED visits in 74 institutions, 183 were
acute admissions (prevalence: 5.4 sepsis per 1000 visits [95% confdence interval (CI): 4.6–6.2)], and 148 were already in
the ED; totaling 331 patients. Hospital mortality was 32% (103/322, 95% CI 23.0–51.0). Age (odds ratio (OR) 1.22 [95%
CI 1.10–1.37]), Sequential Organ Failure Assessment (SOFA) score (OR 1.41 [95% CI 1.28–1.57]), healthcare-associated
infections (OR 2.59 [95% CI 1.24–5.50]) and low-resource institution admission (OR 2.65 [95% CI 1.07–6.90]) were associated with higher mortality. Accredited institutions (OR 0.42 [95% CI 0.21–0.86]) had lower mortality rates. Allocation
within 24 h was adequate in only 52.8% of patients (public hospitals: 42.4% (81/190) vs. private institutions: 67.4% (89/132,
p<0.001) with 39.2% (74/189) of public hospital patients remaining in the ED until discharge, of whom 55.4% (41/74) died.
Sepsis exerts high burden and mortality in Brazilian EDs with frequent inadequate allocation. Modifable factors, such as
resources and quality of care, are associated with reduced mortality.
