Association of 1-hour Sepsis Bundle Achievement and Mortality in Patients with Septic Shock at the Emergency Department of Phon Hospital, Khon Kaen Province
Keywords:
28-Day mortality, emergency department, Hour-1 bundle, septic shockAbstract
Background and Objective: Septic shock is a condition that leads to organ failure and is a major cause of mortality. It has been found that one in three individuals from a population of one million dies from infection, As a result, evidence-based guidelines have been developed to improve patient care and reduce mortality rates. Therefore, this study aims to explore the relationship between adherence to treatment guidelines within the Hour-1 Sepsis Bundle and follow-up at three hours in the emergency department of Phon Hospital and mortality in septic shock patients.
Methods: This is a retrospective cohort study in patients with septic shock who were treated at the emergency department of Phon Hospital from 2019 to 2024. The study adhered to the treatment guidelines within the Hour-1 Sepsis Bundle.
Results: A total of 149 patients were included in the study, with 84.6% in the complete Hour-1 Sepsis Bundle group. The overall 28-day mortality rate was 10%, There was no statistically significant difference in mortality between the complete and incomplete Hour-1 Sepsis Bundles groups (11.9% vs. 21.74%, p = 0.198). Treatment with the complete Hour-1 Sepsis Bundle was not associated with 28-day mortality (odds ratio 0.49, 95% CI [0.16, 1.50], p = 0.211). The completion of each bundle such as blood culture collection before antibiotic administration and lactate measurement, were associated with mortality reduction (odds ratio 0.07, 95% CI [0.01, 0.82], p = 0.034). Factors influencing mortality included urinary tract infection (odds ratio 2.7, 95% CI [1.02, 7.13], p = 0.045), duration of mechanical ventilation (odds ratio 1.27, 95% CI [1.12, 1.45], p < 0.001), and patient transfer to another facility (odds ratio 5.40, 95% CI [1.99, 14.69], p = 0.001).
Conclusions: The complete Hour-1 Sepsis Bundle treatment in septic shock patients in the emergency department was not significantly associated with 28-day mortality. However, multiple factors influence adherence to the treatment bundle. Therefore, it is essential to improve healthcare delivery and accessibility to ensure that septic shock patients receive timely treatment.
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