Factors Influencing Clinical Deterioration in Persons with Sepsis

Patiporn Bunyaphatkun, Siriorn Sindhu, Patricia M Davidson, Ketsarin Utriyaprasit, Chukiat Viwatwongkasem, Wittaya Chartbunchachai


Abstract: Sepsis is a common problem in patients in emergency rooms that need proper management within 72 hours to prevent clinical deterioration. The objective of this study was to determine factors influencing the clinical deterioration of persons with sepsis. A descriptive correlation study was conducted from September 2014 to February 2015 at 11 hospitals in  central Thailand. Recruited into the study were 172 participants presenting with > 2 criteria of systemic inflammatory response syndrome without white blood cell count and shock index >1 at triage, and diagnosed with infectious disease at the 11 emergency departments. Data were collected through interviews, physical examinations and reviewing patients’ charts and were analyzed using descriptive statistics and binary logistic regression. Results showed that symptoms of clinical deterioration manifested in 59.3% of participants. Over 40% demonstrated failure of the circulatory system occurred among 77.5% participants within 24 hours of emergency department arrival. Factors influencing clinical deterioration were higher severity of illness, incomplete triage practices and non-achieved performance of sepsis resuscitation bundle. These factors explained 22% of the variance of clinical deterioration. The implications for nursing practice in improving sepsis care are provision of triage training, development of sepsis fast track, and encouragement of compliances with triage assessment protocols and sepsis resuscitation bundle. 


Clinical deterioration; Emergency care; Influencing factors; Sepsis; Shock; Thailand

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