I believe the SSC data base documents a 23% mortality rate for severe sepsis with normal lactate, normal BP at presentation.
There are a number of observational studies in similarly ill severe sepsis patients, including that of SSC, documenting a mortality penalty associated with triage to the floor before transfer to ICU as compared to triage directly to ICU. I'm aware of no studies showing equivalent or better outcomes for severe sepsis on telemetry on the floors as compared to ICU, even for the not-so-ill patients. I'm aware of no studies randomizing patient assignments to ICU, step-down, telemetry, floors and home, and certainly no publications advocating home. In contrast, the mortality rate at Intermountain Health was 8.7% - 9.7% for *combined* septic shock and severe sepsis (lactates 2.0-3.9), with triage to ICU, Miller RR et al. AJRCCM July 2013. I'm not sure triage to telemetry adds much outcome benefit to to placement on the floors. The outcome benefits of ICU and step-down are perhaps more likely related to greater frequency of vital signs monitoring (Q1-2H vs Q4H on floors and many telemetry units) as well as triage to areas where RNs and MDs are much more familiar with recognition and management of severe sepsis. Based on the above, it seems prudent to triage all patients with severe sepsis to ICU or stepdown whenever permitted by bed availability. While lactate elevation and/or hypotension are important signs of mortality risk, their absence hardly portends a benign outcome. Ron Elkin, MD California Pacific Medical Center San Francisco On Thu, Mar 6, 2014 at 8:38 AM, Karin Molander <[email protected]> wrote: > Does anyone have data/article references regarding lactates of 2 being > sent home or admitted to a floor bed rather than Telemetry bed? > > -- > Karin H. Molander MD > Mills-Peninsula Hospital > Sutter > > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org > >
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