Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection and an important health problem.1Sepsis is a global health problem contributing to high mortality rates as highlighted by several studies. In 2017, the global estimates for sepsis incidence were around 49 million cases, with approximately 19.7% deaths, this increases to 55% of all in-hospital sepsis related deaths.2Data from emergency rooms of USA account for approximately 500,000 ED visits annually with suspected sepsis.3 With each hour delay in effective antimicrobial administration, the mortality of sepsis is expected to increase by 7.6%.4 A significant component of sepsis-related deaths is attributed to “septic shock” which is characterized by persistent hypotension requiring vasopressors and hyper-lactatemia. The mortality from septic shock ranges from 24–41%.5
Across the globe huge sepsis burden are from low and middle -income countries, and 90% deaths attributable from pneumonia, meningitis or other infections from developing countries and majority of deaths dueto sepsis occur in Asia and sub-Saharan Africa.6In Pakistan, the annual incidence of sepsis was 1600–2500 per 100,000, with 30% mortality rate.7
Considering the burden and significant mortality rates associated with sepsis, these patients must be prioritized and managed immediately in order to prevent adverse outcomes including death.To minimize the door to treatment time is even more challenging in overcrowded Emergency Departments (EDs) especially in resource-limited settings like Pakistan. The ED overcrowding and choked throughput is directly related with inadequate management of septic patients like delay in administration of antibiotics.8Hence it is necessary to introduce a purposeful and effective triage tool for ED nurses and physicians to prioritize and manage the patients according to the severity of their illness.9
Emergency severity index (ESI), a widely used tool that was developed in order to assess illness severity, hence to identify the sick patients that need immediate attention at triage. The ESI algorithm is a reliable tool with 4 decision points which provide good assistance with regard to early and reliable identification of patient with sepsis. (Fig.S1)
In ESI, patients are either assigned to one of the five triage categories, ESI level 1 being the most acute and life threatening, while ESI level 5 being the least acute triage category, however patients with ESI levels 1 and 2 are those critical patients who should not wait to be seen and treated.1Patient in category 2 are the one who are clinically unstable (septic or not) and category 3 are one with abnormal vitals.1
This study is aimed to identify the efficacy of ESI tool in early recognition of patients with sepsis and septic shock presented at the triage of our emergency department to help minimize the delay in appropriate management of these patients.