TITLE:
Use of Early Goal-Directed Therapy in the Emergency Department before and after the Sepsis Trilogy
AUTHORS:
Loren K. Reed, Benton R. Hunter, Tyler M. Stepsis
KEYWORDS:
Sepsis, Early Goal-Directed Therapy, Septic Shock, EGDT
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.4 No.2,
June
13,
2016
ABSTRACT: The management of sepsis evolved recently with the publication of three large trials (referred to
as the sepsis trilogy) investigating the efficacy of early goal-directed therapy (EGDT). Our goal was
to determine if the publication of these trials has influenced the use of EGDT when caring for patients
with severe sepsis and septic shock in the emergency department (ED). In February 2014,
we surveyed a sample of board-certified emergency medicine physicians regarding their use of
EGDT in the ED. A follow-up survey was sent after the publication of the sepsis trilogy. Data was
analyzed using 95% confidence intervals to determine if there was a change in the use of EGDT
following the publication of the above trials. Subgroup analyses were also performed with regard
to academic affiliation and emergency department volume. Surveys were sent to 308 and 350
physicians in the pre-and post-publication periods, respectively. Overall, ED use of EGDT did not
change with publication of the sepsis trilogy, 48.7% (CI 39.3% - 58.2%) before and 50.5% (CI
40.6% - 60.3%) after. Subgroup analysis revealed that academic-affiliated EDs significantly decreased
EGDT use following the sepsis trilogy while nonacademic departments significantly increased
EGDT use. Use of EGDT was significantly greater in community departments versus academic
departments following the publication of the sepsis trilogy. There was no change overall in
the use of EGDT protocols when caring for patients with severe sepsis and septic shock, but subgroup
analyses revealed that academic departments decreased their use of EGDT while community
departments increased use of EGDT. This may be due to varying rates of uptake of the medical
literature between academic and community healthcare systems.