To clearly identify the clinical practice and outcome of 1-hour bundle of sepsis in emergency department.

A retrospective cohort analysis was carried out in this study. Patients with septic shock who had been admitted to the emergency department of Zhongda Hospital Affiliated to Southeast University between September 1, 2021 and August 31, 2023 were included. The diagnosis of sepsis or septic shock was according to the criteria of sepsis and septic shock from 2021 Surviving Sepsis Campaign Guidelines. The study subjects were divided into completed group and incompleted group according to that 1- hour bundle was performed or not. Pertinent clinical data including patients’ age, gender, basic diseases and clinical prognosis were collected. Furthermore, SOFA and APACHEⅡ scoring were performed in each patient. Statistical software SPSS 23.0 was used for analysis.

A total of 526 emergency patients were diagnosed with septic shock during the study period. 316 patients were included in the final analysis after screening. The median age of the whole population was 71.0 years and 52.8% were male. The most frequent primary sites of infection were pulmonary, the biliary system and the abdomen. In enrolled patients, the 1-hour bundle was performed in only 15.5% who were included in the completed group. Among the remaining patients, there was one and more treatments was not finished. Fluid resuscitation(74.37%, 235/267) ranked the first place. Secondly, blood culture was conducted before using antibiotics(46.84%, 148/267). Broad-spectrum antimicrobial agents using was the third common unfinished treatment. A total of 104 (32.8%) patients with septic shock died during hospitalization and the median length of hospital stay was 10 days. There were no significant statistical differences in ICU hospitalization, length of hospital stay and hospital mortality between the completed group and the incompleted group. Compared with only one therapy unfinished group, the hospital mortality of two or more unfinished group was increased(35.2% vs. 32.5%), but without statistical differences hospital mortality (P>0.05).

The compliance rate of sepsis 1- hour bundle therapyis still relatively low in emergency department. A poor prognosis may be associated with delays to the initiation of 1-hour bundle therapy. Improvements require further training and quality management for sepsis 1-hour bundle therapy.