Impact of older age and nursing home residence on clinical outcomes of US emergency department visits for severe sepsis

Purpose: The purpose of this study is to compare the impact of older age and nursing home residence on the incidence and morbidity of severe sepsis. Materials and Methods: This was a retrospective analysis of 19 460 emergency department visits from the 2005 to 2009 National Ambulatory Medical Care Surveys with diagnosis of infection with or without severe sepsis (acute organ dysfunction). Clinical outcomes included intensive care unit (ICU) admission, hospital length of stay (LOS), and in-hospital mortality. Results: Older adults (age >= 65 years) were 5-fold more likely to have infections classified as severe sepsis than younger adults (6.5% vs 1.3%), and nursing home residents were 7-fold more likely to have a severe sepsis diagnosis compared with nonnursing home residents (14% vs 1.9%). Among visits for severe sepsis, older adults, compared with younger adults, had modestly higher rates of ICU admission (27% vs 21%), hospital LOS (median, 6 vs 5 days), and in-hospital mortality (24% vs 16%). Nursing home residents with severe sepsis, compared with nonnursing home residents, had significantly higher rates of ICU admission (40% vs 21%), hospital LOS (median, 7 vs 5 days), and in-hospital mortality (37% vs 15%). Conclusions: Older adults and particularly nursing home residents have a disproportionately high incidence of and morbidity from severe sepsis. (C) 2013 Elsevier Inc. All rights reserved.