Activation of a code sepsis in the emergency department is associated with a decrease in mortality

Neus Robert Boter, Josep Maria Mòdol Deltell, Irma Casas Garcia, Gemma Rocamora Blanch, Gemma Lladós Beltran, Anna Carreres Molas

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9 Citations (Scopus)


© 2018 Elsevier España, S.L.U. Objectives: To evaluate the impact of a code sepsis (CS) activation, complying with recommendations, the evolution of patients with severe sepsis in the emergency room and determine independent factors associated to mortality. Method: All patients attending the emergency room with severe sepsis during a 6-month period were included. Complying with Surviving Sepsis Campaign recommendations, patients’ average stay, intensive care admissions and 30-day mortality were assessed. Two groups were compared: CS activation (A) and no activation (NA). Results: A total of 114 episodes were found, 61.4% belonging to group A and 38.6% to NA. Patients in group A presented hypotension more frequently (61.5% vs 34.4%; P =.005). Patients in group NA more frequently had lactate levels of > 3 mmol/L (48.3% vs 80%; P =.01), and abdominal focus of sepsis (34.3% vs 13%; P =.01). In group A, blood cultures were more frequently drawn in the first hour (95% vs 41.7%; P <.001), early antibiotic was administered (76.9% vs 25%; p =.005) and fluid replacement carried out (54.5% vs 18.2%; P =.01). Global achievement of CS objectives was higher in group A (31.4% vs 9.1%; P =.006). In group NA more patients were admitted to the intensive care unit (10% vs 36.4%; P <.001), had longer average stays (10.2 days SD 6.9 vs 14.4 days SD 5.8; P <.001) and a higher mortality rate (4.3% vs 34.1%; P <.001). CRP > 200 mg/l (OR 33.7; P <.001) and the no activation of CS (OR 13.3; p =.001) resulted in being independent factors associated with mortality. Conclusions: The implementation of a CS improves compliance with SSC recommendations and decreases intensive care admissions, average stays and mortality.
Original languageEnglish
Pages (from-to)255-260
JournalMedicina Clinica
Publication statusPublished - 5 Apr 2019


  • Emergency department
  • Sepsis code
  • Severe sepsis


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