What is the incidence and prevalence of sepsis in the Emergency Department (ED)?

Incidence and Prevalence of Sepsis in the Emergency Department

The incidence of sepsis in the Emergency Department (ED) in the United States is approximately 850,000 visits annually, representing about 0.82% of all adult ED visits. 1

Epidemiological Data

United States Specific Data

• According to the Centers for Disease Control and Prevention, the overall incidence of sepsis in the US is >1.7 million adults per year 2
• The National Hospital Ambulatory Medical Care Survey (2009-2011) identified that:
  • 847,868 annual ED visits (0.82% of all adult ED visits) met revised sepsis criteria 1
  • 665,319 visits (0.64%) met original ED sepsis criteria 1
  • 318,832 visits (0.31%) met quick Sequential Organ Failure Assessment (qSOFA) sepsis criteria 1

Global Data

• The global incidence of sepsis was estimated to be 48.9 million cases in 2017 2
• Sepsis accounts for approximately 11 million deaths globally (nearly 20% of all global deaths) 2
• Annual incidence in North America alone is approximately 750,000 cases 3

Mortality and Outcomes

• In-hospital mortality for sepsis patients exceeds 30% in the US 2
• More than 15% of Americans diagnosed with sepsis die annually as a result of their condition 2
• Overall mortality ranges between 28-50% globally 3
• Early progression to septic shock (within 72 hours) is associated with significantly higher 30-day mortality (13.1% vs 3.1% for those who don't progress) 4

Disease Progression and Identification Challenges

• Among ED patients with uncomplicated sepsis, 22.7% progress to severe sepsis or shock within 72 hours of hospital admission 4
• Of patients presenting to the ED with sepsis but without shock, 17.8% progress to shock within 72 hours 4
• Risk factors for progression to shock include:
  • Older age
  • Female sex
  • Hyperthermia
  • Anemia
  • Comorbid lung disease
  • Vascular access device infection 4

Diagnostic Challenges

• 60-75% of ED patients meeting Sepsis-3 criteria do not receive a sepsis discharge diagnosis 5
• Even among patients meeting Sepsis-3 criteria plus shock, only 48-62% receive a sepsis discharge diagnosis 5
• Sepsis is frequently under-diagnosed by ED physicians 6

Sources of Sepsis in the ED

• Pneumonia and urinary tract infections are the most common sources of sepsis in the ED 6
• 50-60% of patients in intensive care units with sepsis or septic shock are admitted directly from the ED 6
• Over half of sepsis cases are community-acquired 6

Economic Impact

• Sepsis accounts for 5.2% of total US hospital costs (>$20 billion in 2011) 2
• The incidence is rising due to an aging population 2

Risk Factors

• Immune compromise
• Chronic diseases (especially malignancy)
• Demographic factors:
  • Infants and elderly persons
  • Male gender
  • Black race 2
• Socioeconomic factors may influence presentation timing and severity 2

Understanding the high incidence and significant mortality associated with sepsis in the ED underscores the importance of early identification and prompt intervention to improve outcomes in this time-critical illness.