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Clinical Disparities in Outcomes for Patients with Sepsis Transported by EMS

Author: Sean MacAllister, BS | |

Associate Authors:

Background/Objective

Sepsis is a life-threatening condition that disproportionately affects racial minority populations. Early recognition by EMS can lead to better outcomes, but variation in sepsis recognition and resulting mortality by race has not been explored. Our objective was to describe patient mortality by race, accounting for EMS sepsis recognition and socioeconomic status (SES).

Methods

This retrospective cohort study used linked EMS and hospital records from the 2021 ESO Data Collaborative. We included 9-1-1 encounters for adult patients (≥ 18 years) with ICD-10 diagnosis codes indicating sepsis. EMS sepsis recognition was defined as a primary or secondary sepsis impression, use of an EHR specialty sepsis form, or a sepsis alert. SES was measured using the CDC Social Vulnerability Index. Sepsis recognition by race was compared using a Chi-
square test. Multivariable logistic regression modeling was used to assess the association between race and mortality for patients with sepsis adjusting for EMS recognition, SES, and clinical sepsis characteristics: altered mental status, hypotension, tachypnea, tachycardia, and fever.

Results

We analyzed 20,172 records for EMS patients diagnosed with sepsis. Overall, 74% were White, 18% were Black, 9% were Hispanic. Median age was younger for Black (64, 53-74) and Hispanic (65, 50-77) patients compared to White patients (72, 61-81). EMS recognized sepsis in 18% (3,553) of patients. Sepsis recognition was similar across races (White: 18.2%, Black: 17.7%, Hispanic: 17.5%, P = 0.68). Overall mortality was 11% (2,229). After adjustment for age, gender, socioeconomic status, clinical sepsis characteristics, and EMS sepsis recognition, Black patients had 23% greater odds of mortality (OR: 1.23, 95% CI: 1.07-1.41) compared to White patients. Odds of mortality did not differ for Hispanic patients compared to White patients (OR: 1.09, 95% CI: 0.90-1.33).

Conclusions

EMS recognized sepsis in fewer than 1-in-5 patients overall. Regardless of EMS sepsis recognition, after adjustment, Black patients had a higher rate of mortality compared to their White counterparts. Limitations include use of a convenience sample and potential missing documentations. Future work is needed to understand the role of social determinants of health in mortality for sepsis.