ED Clinicians Can Contribute to Knowledge About Patients With Severe Infections

Patients with infections account for a significant proportion of emergency department (ED) workload, with many hospital patients admitted with severe sepsis initially investigated and resuscitated in the ED. Additionally, studies based in the intensive care unit (ICU) reveal that the majority of patients with severe infections are admitted after first presenting to the ED and receiving initial diagnostic workup and treatment.

Julian Williams, of the Department of Emergency Medicine at Royal Brisbane and Womens Hospital, and of the School of Medicine at the University of Queensland in Brisbane, Australia, and colleagues, say that, "Given the key role of the ED in diagnosis, risk stratification and initial treatment of patients with infection, it is clear that ED clinicians are ideally placed to contribute significantly to research in this area. Collecting rigorous, quality observational data in this setting will provide the foundation for a significant program of clinical research." Their research was published in BMC Infectious Diseases.

Williams et al. add that the benefits of establishing a comprehensive and detailed prospective database on patients admitted with infection are numerous. They report that the aim of this registry is to systematically collect quality observational clinical and microbiological data regarding emergency patients admitted with infection in order to explore in detail the microbiological profile of these patients, and to provide the foundation for a significant programme of prospective observational studies and further clinical research.

Williams and colleagues report that ED patients admitted with infection will be identified through daily review of the computerized database of ED admissions, and clinical information such as site of infection, physiological status in the ED, and components of management abstracted from patients' charts. This information will be supplemented by further data regarding results of investigations, microbiological isolates, and length of stay (LOS) from hospital electronic databases. Outcome measures will be hospital and intensive care unit (ICU) LOS, and mortality endpoints derived from a national death registry.

The researchers add that this database will provide substantial insights into the characteristics, microbiological profile, and outcomes of emergency patients admitted with infections. It will become the nidus for a program of research into compliance with evidence-based guidelines, optimization of empiric antimicrobial regimens, validation of clinical decision rules and identification of outcome determinants. They add that detailed observational data obtained will provide a solid baseline to inform the design of further controlled trials planned to optimize treatment and outcomes for emergency patients admitted with infections.

Reference: Williams JM, Greenslade JH, McKenzie JV, Chu KH, Brown AFT, Paterson D and Lipman J. A prospective registry of emergency department patients admitted with infection. BMC Infectious Diseases 2011, 11:27doi:10.1186/1471-2334-11-27