Autor: Edgar R. Black, Richard Platt, Kenneth Sands, Paul N. Lanken, Paul S. Graman, Katherine L. Kahn, Patricia L. Hibberd, David R. Snydman, Richard D. Moore, D. Tony Yu, David W. Bates, J. Sanford Schwartz, Jeffrey Parsonnet
Rok vydání: 2003
Předmět:
Zdroj: Critical Care. 7:R24
ISSN: 1364-8535
DOI: 10.1186/cc2171
Popis: Background Treatment of severe sepsis is expensive, often encompassing a number of discretionary modalities. The objective of the present study was to assess intercenter variation in resource and therapeutic modality use in patients with severe sepsis. Methods We conducted a prospective cohort study of 1028 adult admissions with severe sepsis from a stratified random sample of patients admitted to eight academic tertiary care centers. The main outcome measures were length of stay (LOS; total LOS and LOS after onset of severe sepsis) and total hospital charges. Results The adjusted mean total hospital charges varied from $69 429 to US$237 898 across centers, whereas the adjusted LOS after onset varied from 15.9 days to 24.2 days per admission. Treatments used frequently after the first onset of sepsis among patients with severe sepsis were pulmonary artery catheters (19.4%), ventilator support (21.8%), pressor support (45.8%) and albumin infusion (14.4%). Pulmonary artery catheter use, ventilator support and albumin infusion had moderate variation profiles, varying 3.2-fold to 4.9-fold, whereas the rate of pressor support varied only 1.92-fold across centers. Even after adjusting for age, sex, Charlson comorbidity score, discharge diagnosisrelative group weight, organ dysfunction and service at onset, the odds for using these therapeutic modalities still varied significantly across centers. Failure to start antibiotics within 24 hours was strongly correlated with a higher probability of 28-day mortality (r 2 = 0.72).
Databáze: OpenAIRE
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