Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.

<h4>Background</h4>Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these find...

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Autores principales:	Katia Aparecida Pessoa Conde, Eliezer Silva, Carla Oliveira Silva, Elaine Ferreira, Flavio Geraldo Rezende Freitas, Isac Castro, Alvaro Rea-Neto, Cintia Magalhaes Carvalho Grion, Anselmo Dornas Moura, Suzana Margareth Lobo, Luciano Cesar Pontes Azevedo, Flavia Ribeiro Machado
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/884f524e314b49e4bc03844aa33ac60c
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spelling	oai:doaj.org-article:884f524e314b49e4bc03844aa33ac60c2021-11-18T07:42:49ZDifferences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.1932-620310.1371/journal.pone.0064790https://doaj.org/article/884f524e314b49e4bc03844aa33ac60c2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23762255/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.<h4>Materials and methods</h4>This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.<h4>Results</h4>A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.<h4>Conclusions</h4>We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.Katia Aparecida Pessoa CondeEliezer SilvaCarla Oliveira SilvaElaine FerreiraFlavio Geraldo Rezende FreitasIsac CastroAlvaro Rea-NetoCintia Magalhaes Carvalho GrionAnselmo Dornas MouraSuzana Margareth LoboLuciano Cesar Pontes AzevedoFlavia Ribeiro MachadoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 6, p e64790 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Katia Aparecida Pessoa Conde Eliezer Silva Carla Oliveira Silva Elaine Ferreira Flavio Geraldo Rezende Freitas Isac Castro Alvaro Rea-Neto Cintia Magalhaes Carvalho Grion Anselmo Dornas Moura Suzana Margareth Lobo Luciano Cesar Pontes Azevedo Flavia Ribeiro Machado Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
description	<h4>Background</h4>Previous studies showed higher sepsis mortality rates in Brazil compared to other developed or developing countries. Moreover, another trial demonstrated an increased mortality rate in public hospitals compared to private hospitals in Brazil. The reasons for these findings may include delayed recognition and inadequate treatment of sepsis in public facilities. We designed this study to evaluate the factors associated with mortality in septic patients admitted to intensive care units in a network of public and private institutions.<h4>Materials and methods</h4>This study is a retrospective analysis of a prospective cohort of sepsis patients in 19 private and public institutions in Brazil. We analyzed data from the original database and collected additional data to assess compliance to the treatment guidelines and to determine the time from the onset of organ dysfunction and the sepsis diagnosis by the healthcare team.<h4>Results</h4>A total of 396 patients were analyzed. Patients in public hospitals were younger, had a greater number of dysfunctional organs at baseline and a lower chance to have sepsis diagnosed within two hours of the onset of organ dysfunction. Private hospitals had a better compliance to lactate and blood culture sampling and maintenance of glycemic control. The multivariate analysis showed that age, disease severity at baseline and being treated at a public hospital were independent risk factors for mortality. A delay in the sepsis diagnosis of longer than two hours was associated with mortality only in the public setting.<h4>Conclusions</h4>We confirmed a lower sepsis mortality rate in the private hospitals of this network. Being treated in a public hospital was an independent factor for mortality. Delayed recognition of sepsis was more frequent in public institutions and this might have been associated with a higher mortality. Improving sepsis recognition and early diagnosis may be important targets in public institutions.
format	article
author	Katia Aparecida Pessoa Conde Eliezer Silva Carla Oliveira Silva Elaine Ferreira Flavio Geraldo Rezende Freitas Isac Castro Alvaro Rea-Neto Cintia Magalhaes Carvalho Grion Anselmo Dornas Moura Suzana Margareth Lobo Luciano Cesar Pontes Azevedo Flavia Ribeiro Machado
author_facet	Katia Aparecida Pessoa Conde Eliezer Silva Carla Oliveira Silva Elaine Ferreira Flavio Geraldo Rezende Freitas Isac Castro Alvaro Rea-Neto Cintia Magalhaes Carvalho Grion Anselmo Dornas Moura Suzana Margareth Lobo Luciano Cesar Pontes Azevedo Flavia Ribeiro Machado
author_sort	Katia Aparecida Pessoa Conde
title	Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
title_short	Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
title_full	Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
title_fullStr	Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
title_full_unstemmed	Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.
title_sort	differences in sepsis treatment and outcomes between public and private hospitals in brazil: a multicenter observational study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/884f524e314b49e4bc03844aa33ac60c
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Differences in sepsis treatment and outcomes between public and private hospitals in Brazil: a multicenter observational study.

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