Journal of The Korean Society of Emergency Medicine (대한응급의학회지)

The Korean Society of Emergency Medicine (대한응급의학회)
권호 표지

Characteristics and outcomes of patients with septic shock who transferred to the emergency department in tertiary referral center: multicenter, retrospective, observational study

상급종합병원 및 종합병원 응급실로 전원된 패혈성 쇼크 환자의 특성과 예후: 다기관 후향적 관찰연구

  • Kim, Min Gyun (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shin, Tae Gun (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jo, Ik Joon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Won Young (Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ryoo, Seung Mok (Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine) ;
  • Chung, Sung Phil (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Beom, Jin Ho (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Choi, Sung-Hyuk (Department of Emergency Medicine, Korea University College of Medicine, Guro Hospital) ;
  • Kim, Kyuseok (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Jo, You Hwan (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Kang, Gu Hyun (Department of Emergency Medicine, Hallym University College of Medicin) ;
  • Suh, Gil Joon (Department of Emergency Medicine, Seoul National University College of Medicine) ;
  • Shin, Jonghwan (Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine) ;
  • Lim, Tae Ho (Department of Emergency Medicine, Hanyang University College of Medicine) ;
  • Han, Kap Su (Department of Emergency Medicine, Korea University College of Medicine, Anam Hospital) ;
  • Hwang, Sung Yeon (Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Korean Shock Society (KoSS) (Korean Shock Society (KoSS))
  • 김민균 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 신태건 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 조익준 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 응급의학과) ;
  • 유승목 (울산대학교 의과대학 서울아산병원 응급의학과) ;
  • 정성필 (연세대학교 의과대학 응급의학과) ;
  • 범진호 (연세대학교 의과대학 응급의학과) ;
  • 최성혁 (고려대학교 의과대학 구로병원 응급의학과) ;
  • 김규석 (분당서울대학교병원 응급의학과) ;
  • 조유환 (분당서울대학교병원 응급의학과) ;
  • 강구현 (한림대학교 강남성심병원 응급의학과) ;
  • 서길준 (서울대학교 의과대학 응급의학교실) ;
  • 신종환 (서울대학교 의과대학 보라매병원 응급의학과) ;
  • 임태호 (한양대학교 의과대학 응급의학교실) ;
  • 한갑수 (고려대학교 의과대학 안암병원 응급의학과) ;
  • 황승연 (성균관대학교 의과대학 삼성서울병원 응급의학과) ;
  • 대한쇼크연구회 (대한쇼크연구회)
  • Received : 2018.07.11
  • Accepted : 2018.08.14
  • Published : 2018.10.31

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Abstract

Objective: We evaluated the clinical characteristics and prognoses of patients with septic shock who transferred to the emergency department (ED) in a tertiary referral center. Methods: This study was performed using a prospective, multi-center registry of septic shock, with the participation of 11 tertiary referral centers in the Korean Shock Society between October 2015 and February 2017. We classified the patients as a transferred group who transferred from other hospitals after meeting the inclusion criteria upon ED arrival and a non-transferred group who presented directly to the ED. Primary outcome was hospital mortality. We conducted multiple logistic regression analysis to assess variables related to in-hospital mortality. Results: A total of 2,098 patients were included, and we assigned 717 patients to the transferred group and 1,381 patients to the non-transferred group. The initial Sequential Organ Failure Assessment score was higher in the transferred group than the non-transferred group (6; interquartile range [IQR], 4-9 vs. 6; IQR, 4-8; P<0.001). Mechanical ventilator (29% vs. 21%, P<0.001) and renal replacement therapy (12% vs. 9%, P=0.034) within 24 hours after ED arrival were more frequently applied in the transferred group than the non-transferred group. Overall hospital mortality was 22% and there was no significant difference between transferred and non-transferred groups (23% vs. 22%, P=0.820). Multivariable analysis showed an odds ratio for in-hospital mortality of 1.00 (95% confidence interval, 0.78-1.28; P=0.999) for the transferred group compared with the non-transferred group. Conclusion: The transferred group showed higher severity and needed more organ support procedures than the non-transferred group. However, inter-hospital transfer did not affect in-hospital mortality.

Keywords

References

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