Bibliographic record
Abstract
Introduction: Early administration of appropriate antimicrobials is associated with increased survival in patients with septic shock. The potential impact of differences in time to antimicrobial administration in septic shock patients in the ED vs medical and surgical wards is not well studied. Hypothesis: Our goal was to determine the impact of time to initiation of antimicrobial therapy on survival to hospital discharge of patients with septic shock treated in the ED vs medical and surgical wards. Methods: A retrospective review of consecutive adult patients (?18 years of age) who had received a diagnosis of septic shock from 29 participating institutions was performed. Data was collected on demographics, time to antibiotic initiation from first documented hypotension and clinical outcomes. Results: 8,506 cases were found to have the diagnostic criteria for septic shock. The majority of the septic shock cases were found in the emergency department (44.3%), followed by the medical (30.6%) and surgical (15.5%) wards. The mean age for patients found to be in septic shock was 62.6 ± 16.3 years, with 57.1% male. The mean APACHE II score determined from the most abnormal results within 24 hrs of shock onset was 25.6 ± 8.2. The average ICU length of stay was 9.3 ± 11.3 days. Community acquired infections accounted for 59.1% of the cases. The median time for initiation of antibiotics in the ER was 3.5 hrs (IQR, 1.37-7.85) versus 7 hrs for both the surgical (IQR, 3.15-17.83) and medical (IQR, 3.0-17.0) wards. The survival rate for patients admitted with septic shock from the ED was 55.2% vs 47.3% and 36.9% for the surgical and medical wards respectively. The adverse impact on survival due to delays was consistent across all groups (p<.0001). Conclusions: Patients acquiring septic shock on the wards have a significantly longer time to appropriate antimicrobial therapy from documentation of hypotension than those admitted through the ED. Variations in time to appropriate antimicrobial therapy may play a substantial role in the excess mortality of nosocomial septic shock. Efforts to decrease septic shock mortality focusing on minimizing delays of therapy to ward patients may have a disproportionate beneficial impact on improving septic shock outcome.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.592 | 0.477 |
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".