The Ramathibodi early warning score as a sepsis screening tool does not reduce the timing of antibiotic administration
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Issued Date
2022-12-01
Resource Type
ISSN
18651372
eISSN
18651380
Scopus ID
2-s2.0-85129702911
Journal Title
International Journal of Emergency Medicine
Volume
15
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Emergency Medicine Vol.15 No.1 (2022)
Suggested Citation
Suttapanit K., Dangprasert K., Sanguanwit P., Supatanakij P. The Ramathibodi early warning score as a sepsis screening tool does not reduce the timing of antibiotic administration. International Journal of Emergency Medicine Vol.15 No.1 (2022). doi:10.1186/s12245-022-00420-w Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/85315
Title
The Ramathibodi early warning score as a sepsis screening tool does not reduce the timing of antibiotic administration
Author's Affiliation
Other Contributor(s)
Abstract
Background: Administration of antibiotics to septic patients within 1 h was recommended in 2018 by the Surviving Sepsis Campaign (SSC) as a strategy to improve survival outcomes. The use of sepsis screening tools in emergency departments (EDs) is important for early diagnosis and initiation of sepsis care. This study aimed to assess the impact of the Ramathibodi early warning score (REWs) on the administration of antibiotics within 1 h of presentation. Methods: This was an observational retrospective cohort study with propensity score matching between the sepsis-3 criteria (pre-period) and the REWs (post-period) as screening tools in adult patients with sepsis in EDs. The primary outcome was the proportion of receiving antibiotics within 1 h of presentation in the pre- and post-periods. Results: A total of 476 patients were analyzed without propensity matching. The proportion of antibiotic administration within 1 h was higher in patients screened using the REWs compared with standard of care in the total study population (79.5% vs. 61.4%, p < 0.001). After propensity score matching, 153 patients were included in both groups. The proportion of antibiotic administration within 1 h was similar in patients screened using the REWs and those receiving standard of care (79.7% vs. 80.4%, p = 0.886). However, time to intensive care unit (ICU) admission was faster in patients screened using the REWs. Delays in receiving antibiotics of longer than 3 h were associated with increased mortality (adjusted hazard ratio 7.04, 95% confidence interval 1.45 to 34.11, p = 0.015). Conclusions: Implementing the REWs as a tool in sepsis screening protocols in EDs did not improve rates of antibiotic administration within 1 h as recommended by the SSC. However, time to ICU admission was improved after implementation of the REWs.