Utilization and Outcomes of Drotrecogin Alfa (Activated) for Sepsis in Critically Ill Patients at a Community Acute Care Hospital
Bibliographic record
Abstract
ABSTRACT Background: Institutional criteria are in place within the author’s institution to optimize and facilitate the use of drotrecogin alfa (activated) (DAA). Objectives: The primary objective was to evaluate the appropriateness of DAA utilization. The secondary objectives were to characterize the patients and types of infections for which DAA was used and to evaluate mortality in the intensive care unit (ICU), mortality at 28 days, serious bleeding events during the infusion, and wastage of this agent in clinical practice at the author’s institution. Methods: Charts of patients who received DAA from the time it was first marketed in Canada in 2003 until April 2007 in a 9-bed medical–surgical ICU in a community acute care hospital were evaluated retrospectively. Results: Of the 27 patients who received DAA, the therapy was appropriate for 26 (96%). The mean score (± standard deviation) for the Acute Physiology and Chronic Health Evaluation (APACHE II) was 28 ± 4, and the mean number of dysfunctional organs or systems was 3 ± 0.9. The mortality rate in the ICU was 44%, and the 28-day mortality rate was 60%. Serious bleeding during the infusion occurred in 2 (7%) of the patients. Wastage of DAA totalled 145 mg for 10 (37%) of the patients. Half of the wastage (70 mg, at a total cost of about $4700) occurred because fresh DAA supplies were prepared by the pharmacy before completion of the current bag. Conclusions: Use of a preprinted order facilitated appropriate DAA utilization. Mortality and bleeding rates were higher than those in randomized controlled trials. Wastage could be minimized by not preparing supplies of DAA before the current bag is finished. This study illustrates the importance of drug-use evaluations and institutional guidelines to facilitate appropriate utilization of DAA. RESUME Contexte : L’etablissement de l’auteure a des criteres mis en place pour optimiser et faciliter l’emploi de drotrecogine alpha (activee) (DAA). Objectifs : Le principal objectif etait d’evaluer la pertinence de l’emploi de la DAA. Les objectifs secondaires etaient, d’une part, de caracteriser les patients ainsi que les types d’infections pour lesquels ont avait recours a la DAA, et, d’autre part, d’evaluer le taux de mortalite a l’unite de soins intensifs (USI) et a 28 jours, le taux d’hemorragies graves pendant la perfusion, et le gaspillage de cet agent en pratique clinique a l’etablissement ou exerce l’auteure. Methodes : Les dossiers medicaux des patients de l’USI medicochirurgicale de 9 lits d’un hopital communautaire de soins de courte duree, qui ont recu de la DAA depuis sa mise en marche au Canada en 2003 jusqu’en avril 2007, ont ete evalues. Resultats : Chez les 27 patients qui ont recu de la DAA, le traitement etait pertinent pour 26 (96 %) d’entre eux. Le score moyen (± l’ecart-type) a l’indice APACHE II (Acute Physiology and Chronic Health Evaluation) etait de 28 ± 4, et le nombre moyen d’organes ou de systemes en defaillance etait de 3 ± 0,9. Le taux de mortalite a l’USI etait de 44 %, et celui a 28 jours, de 60 %. Des hemorragies graves sont survenues durant la perfusion chez 2 (7 %) des patients. Le gaspillage de DAA a ete de 145 mg pour 10 (37 %) patients. La moitie de cette quantite (70 mg, pour un cout total d’environ 4700 $) a ete gaspillee parce que le pharmacien avait prepare un approvisionnement de DAA frais avant que ne soit epuise le sac en cours d’utilisation. Conclusions : Le recours a un systeme d’ordonnances preimprimees a facilite l’emploi pertinent de la DAA. Les taux de mortalite et d’hemorragies etaient superieurs a ceux observes dans les etudes comparatives aleatoires. Le gaspillage pourrait etre reduit en ne preparant pas d’approvisionnement de DAA avant que ne soit epuise le sac en cours d’utilisation. Cette etude montre l’importance de l’evaluation de l’utilisation des medicaments et des lignes directrices de l’etablissement pour faciliter l’emploi pertinent de DAA.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".