Vague Presenting Symptoms Are Associated with Increased Mortality in Septic Shock

 Authors: Filbin MR et al. 

Crit Care Med 2018 Jun 29

Sepsis can be both deadly and difficult to recognize. It is not clear whether treatment delays, such as delayed antibiotic administration, reflect poor recognition, poor quality care, or something else. To examine whether absence of explicit infectious presenting symptoms (fever, chills, rigors, productive cough, dysuria, or skin infection) is associated with delayed antibiotic administration or increased mortality, researchers reviewed records for 654 adult patients at a single academic hospital who met Centers for Medicare and Medicaid Services definition of septic shock.

Overall, 409 patients presented to the emergency department with explicit symptoms and 245 (37%) with only vague symptoms (e.g., weakness, fatigue, abdominal pain without fever). Patients with vague symptoms were older (median age, 68 vs. 65 years) and sicker, with higher rates of hypotension, intubation, and elevated lactate.

Although physicians recognized that patients with vague symptoms were seriously ill — more patients with vague than with explicit symptoms were triaged to the acute care area — they flagged sepsis less frequently for patients with vague symptoms. Time to antibiotics was significantly longer for patients with vague symptoms (median, 1.6 vs. 0.8 hours) and mortality was significantly higher (34% vs. 16%). However, while vague symptoms were independently associated with significantly increased mortality on multivariable analysis, delayed antibiotics were not.