Multicentre observational study of adherence to Sepsis Six guidelines in emergency general surgery
Authors:   UK National Surgical Research Collaborative, Blencowe N S , Strong S , Blazeby J , Daniels R , Peden C , Lim J , Messenger D , Stark H , Richards S , Rogers C , Trickey A , Carpenter C , Fadhlillah M , Jai W , Balakumar R , McHugh R , Proctor V , Wild J , Aldugman S , Atwell A , Buchan L , Castellimo N , Craig N , Dindyal S , Hansell F , Haque A , Magee S , Manson J , Menon J , Tuckmacjy H , McDermott F , Lotfi N , Sarmah P , Allen N , Heywood N , Rees A , Brigic A , Ali A , Brown J , Gupta S , Hui D , Lewis R , Bagenal J , Dua A , Khatri C , Park C , Bennett J , Brennan A , Pearce O , Shah R , Twelves D , Woods S , Jarvis A , White A , Blower E , Veitch J , Nicholson G , Chatzikonstantinou M , Wheatstone S , Shaban F , Bartlett A , Kimble A , Glazier J , Jones M , Pengelli S , Al-Jundi W , El Sharif M , Frizzini C , Wilson T , Ashman A , Fallaize R , Hallam S , Simmons L , Frank L , Griggs R , Hardy T , Lyn-White N , Mason M , Carnaby G , Jhah J , Stuttaford L , Upchurch E , Cunha P , Kaptanis S , Tayeh S , Shamsul M , Games K , Iftikhar H , Parthasarathy M , Bonastos V , Taffaha H , Bew D , Ng J , Liasis L , Gerçek Y , Moos B , Reilly J , Hicks G , Chawla A , Miller A , Satheesan K , Duncan A , Vlachogiorgis A , Sengupta N , Mowbray N , Barrow E , Smith S , Fudulu D , Hanks K , Jones A , McNair A , Oliphant Z , Weaver H , Ranga N , Chisti T , Imatitikua T , Jones T , Khan A , Ogunrinde I , Mittapalli D , Powell-Bowns M , Samuel M , Wilson M , Bilki D , Nepdodiev D , Panagiotopoulou Y , Halkias C , Cattle K , Challand C , Bandari S , Chambers A , Nguyen J , Walker K , Zamurrad M , Asarbakhsh M , Cracium M , Fatine Y , Khan S , Lort S , Futaba K , Ban V , Cheng J , Kambasha C , Rizki H , Somaratne K , Wilson A , Al Omran Y , Anwuzia-iwegbu C , Yakandawala G , Richards C , Warner B , Graffy H , MacInnes E , Nicholas J , Zakeri R , Barrow P , Doran J , Ewan L , Hancock L , Law J , Brewer H , Henderson I , Palser T , Murphy J , Nduwayo S , Saggu G , Brown C , Brown E , Dyke K , Evans T , Jenkins M , Lowe J , Brown C , Preet R , O'Reilly D , Symons N , Torrance H , Corbett D , Kelly M , Khan T , Ali M , Poon S , Charleston P , Gill M , Martin J , Overton J , Sekhar H , Adam U , Almari F , Basson R , Denny N , Khaw R , Goatman C , Slawinski C , Evans R , Davies O , Halls M , Hotton E , Markham R , Potter S , Foster M , Peristakeris I , Shaw S , Marsden M , Alshakarch J , Ritchie J , Bajalan M , Choh C , Ahmed H , Khan F , Yasin S , Zafar A , Oderuth E , Sheel A , Yuen-Chang F , Capozzi P , McGlone E , Loh Y , Cheong Soon W , Merrifield C , Scott A , El Kafsi J , Warner N , Mohan H , Thomson P , Renshaw S , Walker D , Carpenter C , Browning D , Burdall O , Butcher K , Greenwood A , Harris E , Merker L , Pegna V , Stark H , El-Sayed C , Gaunt A , Capozzi P , Newton K , Nicholson J , Pearce L , Brown C , Brown J , Jones A , Satherley L , Evans A , Lazarova L , Mcavoy A , Spreadborough P , Amin A , Bretherton C , Chapman A , Fleet M , Challand C , Jawad Z , Al-Hallao S , Botha E , Garcia P , Honeyman C , Byrne C , Kabir I , Nana G , English W , Broome J , Gilmore L , Goldsmith P , Krishnamohan N , Matsumoto K , Ren K , Rengifo C , West H , Ellison A , Lloyd E , Stewart D , Stimpson A , Jones A , Taylor G , Clutton J , Mortimer M , Mulla M , Downey A , Houston M , Rapson K , Davis N , Humphreys L , Barnard J , Egbeare D , Whitlaw M , Zakirova R 
Published: January 2017

Abstract

Background
Evidence-based interventions may reduce mortality in surgical patients. This study documented the prevalence of sepsis, adherence to guidelines in its management, and timing of source control in general surgical patients presenting as an emergency.

Methods
Patients aged 16 years or more presenting with emergency general surgery problems were identified over a 7-day period and then screened for sepsis compliance (using the Sepsis Six standards, devised for severe sepsis) and the timing of source control (whether radiological or surgical). Exploratory analyses examined associations between the mode (emergency department or general practitioner) and time of admission, adherence to the sepsis guidelines, and outcomes (complications or death within 30 days).

Results
Of a total of 5067 patients from 97 hospitals across the UK, 911 (18·0 per cent) fulfilled the criteria for sepsis, 165 (3·3 per cent) for severe sepsis and 24 (0·5 per cent) for septic shock. Timely delivery of all Sepsis Six guidelines for patients with severe sepsis was achieved in four patients. For patients with severe sepsis, 17·6–94·5 per cent of individual guidelines within the Sepsis Six were delivered. Oxygen was the criterion most likely to be missed, followed by blood cultures in all sepsis severity categories. Surgery for source control occurred a median of 19·8 (i.q.r. 10·0–35·4) h after diagnosis. Omission of Sepsis Six parameters did not appear to be associated with an increase in morbidity or mortality.

Conclusion
Although sepsis was common in general surgical patients presenting as an emergency, adherence to severe sepsis guidelines was incomplete in the majority. Despite this, no evidence of harm was apparent.