학술논문
Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery
Document Type
Report
Author
Blencowe, N. S.; Strong, S.; Blazeby, J.; Daniels, R.; Peden, C.; Lim, J.; Messenger, D.; Stark, H.; Richards, S.; Rogers, C.; Trickey, A.; Carpenter, C.; Fadhlillah, M.; Jai, W.; Balakumar, R.; McHugh, R.; Proctor, V.; Wild, J.; Aldugman, S.; Atwell, A.; Buchan, L.; Castellimo, N.; Craig, N.; Dindyal, S.; Hansell, F.; Haque, A.; Magee, S.; Manson, J.; Menon, J.; Tuckmacjy, H.; McDermott, F.; Lotfi, N.; Sarmah, P.; Allen, N.; Heywood, N.; Rees, A.; Brigic, A.; Ali, A.; Brown, J.; Gupta, S.; Hui, D.; Lewis, R.; Bagenal, J.; Dua, A.; Khatri, C.; Park, C.; Bennett, J.; Brennan, A.; Pearce, O.; Shah, R.; Twelves, D.; Woods, S.; Jarvis, A.; White, A.; Blower, E.; Veitch, J.; Nicholson, G.; Chatzikonstantinou, M.; Wheatstone, S.; Shaban, F.; Bartlett, A.; Kimble, A.; Glazier, J.; Jones, M.; Pengelli, S.; Al-Jundi, W.; El Sharif, M.; Frizzini, C.; Wilson, T.; Ashman, A.; Fallaize, R.; Hallam, S.; Simmons, L.; Frank, L.; Griggs, R.; Hardy, T.; Lyn-White, N.; Mason, M.; Carnaby, G.; Jhah, J.; Stuttaford, L.; Upchurch, E.; Cunha, P.; Kaptanis, S.; Tayeh, S.; Shamsul, M.; Games, K.; Iftikhar, H.; Parthasarathy, M.; Bonastos, V.; Taffaha, H.; Bew, D.; Ng, J.; Liasis, L.; Gercek, Y.; Moos, B.; Reilly, J.; Hicks, G.; Chawla, A.; Miller, A.; Satheesan, K.; Duncan, A.; Vlachogiorgis, A.; Sengupta, N.; Mowbray, N.; Barrow, E.; Smith, S.; Fudulu, D.; Hanks, K.; Jones, A.; McNair, A.; Oliphant, Z.; Weaver, H.; Ranga, N.; Chisti, T.; Imatitikua, T.; Jones, T.; Khan, A.; Ogunrinde, I.; Mittapalli, D.; Powell-Bowns, M.; Samuel, M.; Wilson, M.; Bilki, D.; Nepdodiev, D.; Panagiotopoulou, Y.; Halkias, C.; Cattle, K.; Challand, C.; Bandari, S.; Chambers, A.; Nguyen, J.; Walker, K.; Zamurrad, M.; Asarbakhsh, M.; Cracium, M.; Fatine, Y.; Khan, S.; Lort, S.; Futaba, K.; Ban, V.; Cheng, J.; Kambasha, C.; Rizki, H.; Somaratne, K.; Wilson, A.; Al Omran, Y.; Anwuzia-iwegbu, C.; Yakandawala, G.; Richards, C.; Warner, B.; Graffy, H.; MacInnes, E.; Nicholas, J.; Zakerhi, R.; Barrow, P.; Doran, J.; Ewan, L.; Hancock, L.; Law, J.; Brewer, H.; Henderson, I.; Palser, T.; Murphy, J.; Nduwayo, S.; Saggu, G.; Brown, C.; Brown, E.; Dyke, K.; Evans, T.; Jenkins, M.; Lowe, J.; Preet, R.; O'Reilly, D.; Symons, N.; Torrance, H.; Corbett, D.; Kelly, M.; Khan, T.; Ali, M.; Poon, S.; Charleston, P.; Gill, M.; Martin, J.; Overton, J.; Sekhar, H.; Adam, U.; Almari, F.; Basson, R.; Denny, N.; Khaw, R.; Goatman, C.; Slawinski, C.; Evans, R.; Davies, O.; Halls, M.; Hotton, E.; Markham, R.; Potter, S.; Foster, M.; Peristakeris, I.; Shaw, S.; Marsden, M.; Alshakarch, J.; Ritchie, J.; Bajalan, M.; Choh, C.; Ahmed, H.; Khan, F.; Yasin, S.; Zafar, A.; Oderuth, E.; Sheel, A.; Yuen-Chang, F.; Capozzi, P.; McGlone, E.; Loh, Y.; Cheong Soon, W.; Merrifield, C.; Scott, A.; El Kafsi, J.; Warner, N.; Mohan, H.; Thomson, P.; Renshaw, S.; Walker, D.; Browning, D.; Burdall, O.; Butcher, K.; Greenwood, A.; Harris, E.; Merker, L.; Pegna, V.; El-Sayed, C.; Gaunt, A.; Newton, K.; Nicholson, J.; Pearce, L.; Satherley, L.; Evans, A.; Lazarova, L.; Mcavoy, A.; Spreadborough, P.; Amin, A.; Bretherton, C.; Chapman, A.; Fleet, M.; Jawad, Z.; Al-Hallao, S.; Botha, E.; Garcia, P.; Honeyman, C.; Byrne, C.; Kabir, I.; Nana, G.; English, W.; Broome, J.; Gilmore, L.; Goldsmith, P.; Krishnamohan, N.; Matsumoto, K.; Ren, K.; Rengifo, C.; West, H.; Ellison, A.; Lloyd, E.; Stewart, D.; Stimpson, A.; Taylor, G.; Clutton, J.; Mortimer, M.; Mulla, M.; Downey, A.; Houston, M.; Rapson, K.; Davis, N.; Humphreys, L.; Barnard, J.; Egbeare, D.; Whitlaw, M.; Zakirova, R.
Source
British Journal of Surgery. Jan, 2017, Vol. 104 Issue 2, pe165, 7 p.
Subject
Language
English
ISSN
0007-1323
Abstract
Byline: UK National Surgical Research Collaborative, N. S. Blencowe, S. Strong, J. Blazeby, R. Daniels, C. Peden, J. Lim, D. Messenger, H. Stark, S. Richards, C. Rogers, A. Trickey, C. Carpenter, M. Fadhlillah, W. Jai, R. Balakumar, R. McHugh, V. Proctor, J. Wild, S. Aldugman, A. Atwell, L. Buchan, N. Castellimo, N. Craig, S. Dindyal, F. Hansell, A. Haque, S. Magee, J. Manson, J. Menon, H. Tuckmacjy, F. McDermott, N. Lotfi, P. Sarmah, N. Allen, N. Heywood, A. Rees, A. Brigic, A. Ali, J. Brown, S. Gupta, D. Hui, R. Lewis, J. Bagenal, A. Dua, C. Khatri, C. Park, J. Bennett, A. Brennan, O. Pearce, R. Shah, D. Twelves, S. Woods, A. Jarvis, A. White, E. Blower, J. Veitch, G. Nicholson, M. Chatzikonstantinou, S. Wheatstone, F. Shaban, A. Bartlett, A. Kimble, J. Glazier, M. Jones, S. Pengelli, W. Al-Jundi, M. El Sharif, C. Frizzini, T. Wilson, A. Ashman, R. Fallaize, S. Hallam, L. Simmons, L. Frank, R. Griggs, T. Hardy, N. Lyn-White, M. Mason, G. Carnaby, J. Jhah, L. Stuttaford, E. Upchurch, P. Cunha, S. Kaptanis, S. Tayeh, M. Shamsul, K. Games, H. Iftikhar, M. Parthasarathy, V. Bonastos, H. Taffaha, D. Bew, J. Ng, L. Liasis, Y. Gercek, B. Moos, J. Reilly, G. Hicks, A. Chawla, A. Miller, K. Satheesan, A. Duncan, A. Vlachogiorgis, N. Sengupta, N. Mowbray, E. Barrow, S. Smith, D. Fudulu, K. Hanks, A. Jones, A. McNair, Z. Oliphant, H. Weaver, N. Ranga, T. Chisti, T. Imatitikua, T. Jones, A. Khan, I. Ogunrinde, D. Mittapalli, M. Powell-Bowns, M. Samuel, M. Wilson, D. Bilki, D. Nepdodiev, Y. Panagiotopoulou, C. Halkias, K. Cattle, C. Challand, S. Bandari, A. Chambers, J. Nguyen, K. Walker, M. Zamurrad, M. Asarbakhsh, M. Cracium, Y. Fatine, S. Khan, S. Lort, K. Futaba, V. Ban, J. Cheng, C. Kambasha, H. Rizki, K. Somaratne, A. Wilson, Y. Al Omran, C. Anwuzia-iwegbu, G. Yakandawala, C. Richards, B. Warner, H. Graffy, E. MacInnes, J. Nicholas, R. Zakerhi, P. Barrow, J. Doran, L. Ewan, L. Hancock, J. Law, H. Brewer, I. Henderson, T. Palser, J. Murphy, S. Nduwayo, G. Saggu, C. Brown, E. Brown, K. Dyke, T. Evans, M. Jenkins, J. Lowe, C. Brown, R. Preet, D. O'Reilly, N. Symons, H. Torrance, D. Corbett, M. Kelly, T. Khan, M. Ali, S. Poon, P. Charleston, M. Gill, J. Martin, J. Overton, H. Sekhar, U. Adam, F. Almari, R. Basson, N. Denny, R. Khaw, C. Goatman, C. Slawinski, R. Evans, O. Davies, M. Halls, E. Hotton, R. Markham, S. Potter, M. Foster, I. Peristakeris, S. Shaw, M. Marsden, J. Alshakarch, J. Ritchie, M. Bajalan, C. Choh, H. Ahmed, F. Khan, S. Yasin, A. Zafar, E. Oderuth, A. Sheel, F. Yuen-Chang, P. Capozzi, E. McGlone, Y. Loh, W. Cheong Soon, C. Merrifield, A. Scott, J. El Kafsi, N. Warner, H. Mohan, P. Thomson, S. Renshaw, D. Walker, C. Carpenter, D. Browning, O. Burdall, K. Butcher, A. Greenwood, E. Harris, L. Merker, V. Pegna, H. Stark, C. El-Sayed, A. Gaunt, P. Capozzi, K. Newton, J. Nicholson, L. Pearce, C. Brown, J. Brown, A. Jones, L. Satherley, A. Evans, L. Lazarova, A. Mcavoy, P. Spreadborough, A. Amin, C. Bretherton, A. Chapman, M. Fleet, C. Challand, Z. Jawad, S. Al-Hallao, E. Botha, P. Garcia, C. Honeyman, C. Byrne, I. Kabir, G. Nana, W. English, J. Broome, L. Gilmore, P. Goldsmith, N. Krishnamohan, K. Matsumoto, K. Ren, C. Rengifo, H. West, A. Ellison, E. Lloyd, D. Stewart, A. Stimpson, A. Jones, G. Taylor, J. Clutton, M. Mortimer, M. Mulla, A. Downey, M. Houston, K. Rapson, N. Davis, L. Humphreys, J. Barnard, D. Egbeare, M. Whitlaw, R. Zakirova 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 (18ae0 per cent) fulfilled the criteria for sepsis, 165 (3ae3 per cent) for severe sepsis and 24 (0ae5 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, 17ae6-94ae5 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 19ae8 (i.q.r. 10ae0-35ae4) 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. Article Note: Members of the UK National Surgical Research Collaborative are co-authors of this study and can be found under the heading Collaborators CAPTION(S): Appendix S1 Definitions of sepsis (Word document) Appendix S2 Definitions of complications (Word document)