Four consecutive yearly point-prevalence studies in Wales indicate lack of improvement in sepsis care on the wards

The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were completed. There was no significant correlation between bundle element compliance, NEWS or year of study. One hundred and seventy (10.7%) patients were seen by critical care outreach; the ‘Sepsis Six’ bundle was completed significantly more often in this group (54/170, 32.0%) than for patients who were not reviewed by critical care outreach (168/1385, 11.6%; p < 0.0001). Overall survival to 30 days was 81.7% (1349/1651), with a mean survival time of 26.5 days (95% CI 26.1–26.9) with no difference between each year of study. 90-day survival for years 2017–2019 was 74.7% (949/1271), with no difference between the years. In multivariate regression we identified older age, heart failure, recent chemotherapy, higher frailty score and do not attempt cardiopulmonary resuscitation orders as significantly associated with increased 30-day mortality. Our data suggests that despite efforts to increase sepsis awareness within the NHS, there is poor compliance with the sepsis care bundles and no change in the high mortality over the study period. Further research is needed to determine which time-sensitive ward-based interventions can reduce mortality in patients with sepsis and how can these results be embedded to routine clinical practice

Selected characteristics of breast cancer cases and controls among Hong Kong Chinese women, 2011–2014^a.

<p>Selected characteristics of breast cancer cases and controls among Hong Kong Chinese women, 2011–2014<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0120741#t001fn002" target="_blank">^a</a>.</p

Odds ratios of breast cancer and by estrogen receptor (ER) status in Hong Kong Chinese women with a history of any cancer or breast cancer in the first-degree relatives.

<p>Odds ratios of breast cancer and by estrogen receptor (ER) status in Hong Kong Chinese women with a history of any cancer or breast cancer in the first-degree relatives.</p

Odds ratios of all breast cancers and the ER+ breast cancers in Hong Kong Chinese women with a history of breast cancer in first-degree relatives, stratified by menopausal status.

<p>Odds ratios of all breast cancers and the ER+ breast cancers in Hong Kong Chinese women with a history of breast cancer in first-degree relatives, stratified by menopausal status.</p