International Emergency Medicine
Background: Sepsis is a leading cause of death worldwide. Early recognition and treatment are essential for mortality reduction. There is limited data on the burden and treatment of sepsis in low and middle-income countries, especially in Central America and the Caribbean. We sought to characterize the burden of sepsis among patients admitted to a hospital in Belize and the generalizability of the quick Sequential Organ Function Assessment (qSOFA) score and Emergency Triage and Treatment (ETAT) emergency signs as sepsis screening tools for the adult and pediatric population, respectively.
Methods: We performed a single-site retrospective review of patients admitted from the Emergency Department (ED) at the largest public referral hospital in Belize with approximately 25,000 annual ED visits. We reviewed paper and electronic medical records for patients admitted from October 2017 to September 2018 with a diagnosis suggestive of infection. We trained ED nurses and physicians in a sepsis screening protocol in October 2018.
Results: There was a total of 3,703 admissions during the review period, and we identified 1,693 (46%) admissions with a diagnosis suggestive of infection. Only 21 (1.2%) patients had sepsis documented as an admission diagnosis. We conducted further medical record review of 111 of the admissions of which 65 (59%) patients were adults aged 18 years and older. Using Sepsis-3 criteria and an adjusted pediatric SOFA score, 32 (29%) patients met the definition of sepsis. In the pediatric population, a positive ETAT emergency sign was poorly sensitive for sepsis (33%). Among adults, a qSOFA score ≥ 2 in the ED was poorly sensitive for sepsis (40%) and 30-day mortality (50%). A qSOFA score ≥ 1 had higher sensitivities for sepsis (80%) and 30-day mortality (83%) while meeting 2 Systemic Inflammatory Response Syndrome (SIRS) criteria had a sensitivity of 75% for sepsis. Overall 30-day adult mortality was 9.2%.
Conclusions: We observed a trend of under-diagnosis of patients with sepsis at this public hospital in Belize. Although qSOFA and ETAT emergency signs are poorly sensitive for sepsis, implementation of a new sepsis screening protocol can potentially improve the ED diagnosis and treatment of sepsis.