Original Research

Closing the sepsis gap: an exploration of sepsis presentations at a remote north Australian emergency department

AUTHORS

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John James van Bockxmeer1
MpHTM, MBBS, District Medical Officer *

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Amith Shetty2
PhD, MBBS, Research Co-Director and Medical Lead

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Tim Robertson3
MBBS, Resident Medical Officer

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Yarlalu Thomas4
BSC, Aboriginal Precision Public Health Fellow

AFFILIATIONS

1 Western Australian Country Health Service, Hedland Health Campus, WA 6722, Australia

2 Western Sydney Local Health District, Westmead Hospital, Sydney, NSW 2145, Australia

3 Child and Adolescent Health Service, Perth Children’s Hospital, Perth, WA 6009, Australia

4 Western Australian Register of Developmental Anomalies, Western Australian Department of Health, Perth, WA 6849, Australia

ACCEPTED: 9 July 2021


early abstract:

Objective: To explore the demographic characteristics, disease specifics and outcomes of adult patients with suspected sepsis presenting to a remote Australian Emergency Department (ED).
Design, Setting and Participants: Retrospective uninterrupted time series audit of ED patients presenting with suspected sepsis. 189 remote presentations were reviewed based on the time of clinician identification of sepsis.
Methods: Retrospective cohort analysis was performed for all adult patients with suspected or confirmed sepsis.
Results: A majority of patients presenting with sepsis to a remote hospital were Indigenous (61.9%) with a large proportion (34.9%) presenting via ambulance. Median age was 50 years. Indigenous patients (44.7% 95% CI 34.1-55.9) were more likely to meet the qSOFA criteria compared to non-Indigenous patients (27.1% 95% CI 16.6-41.0) (p=0.05 95% CI -1.1-34.3) with higher rates of critical care admission (34.2% v 10.4%) (difference 23.8 p=0.003 95% CI 7.7-37.5). Congruent with previous research, Indigenous status did not confer a difference in sepsis mortality (12.1% v 11.8% p=0.91).
Conclusion: Remote Indigenous patients have worse clinical sepsis scores, are more likely to present by ambulance and require skin and soft tissue source control. This cohort has higher lactate values and critical care requirements but similar mortality rates. Improving access to culturally safe medical care could address this disparity.