LAUSR

Objective: To evaluate the association between total medical contact, prehospital, and emergency department delays in antibiotic administration and in-hospital mortality among patient encounters with community-acquired sepsis. Design: Retrospective cohort study. Setting: Nine hospitals served by 21 emergency medical services agencies in southwestern Pennsylvania from 2010 through 2012. Patients: All emergency medical services encounters with community acquired sepsis transported to the hospital. Measurements and Main Results: Among 58,934 prehospital encounters, 2,683 had community-acquired sepsis, with an in-hospital mortality of 11%. Median time from first medical contact to antibiotic administration (total medical contact delay) was 4.2 hours (interquartile range, 2.7–8.0 hr), divided into a median prehospital delay of 0.52 hours (interquartile range, 0.40–0.66 hr) and a median emergency department delay of 3.6 hours (interquartile range, 2.1–7.5 hr). In a multivariable analysis controlling for other risk factors, total medical contact delay was associated with increased in-hospital mortality (adjusted odds ratio for death, 1.03 [95% CI, 1.00–1.05] per 1-hr delay; p < 0.01), as was emergency department delay (p = 0.04) but not prehospital delay (p = 0.61). Conclusions: Both total medical contact and emergency department delay in antibiotic administration are associated with in-hospital mortality in community-acquired sepsis.