Integrated Sepsis Detection Protocols Using Clinical Scores and Laboratory Triggers Versus Routine Assessment in Adult Emergency Patients

Abstract

Background:
Integrated sepsis detection protocols combining clinical scores with laboratory triggers are increasingly used in emergency departments, but their added value over routine assessment remains uncertain.
Methods:
A PubMed search identified studies comparing integrated sepsis detection protocols (clinical score plus laboratory trigger) with routine clinician assessment in adult emergency settings. Two reviewers selected studies, extracted data, and assessed risk of bias. Primary outcomes were time to antibiotics, intensive care unit (ICU) admission, and mortality; secondary outcomes were process measures and length of stay.
Results:
Fourteen studies (2 randomised or pragmatic trials, 12 cohort or beforeafter; >20,000 patients) were included. Integrated protocols consistently shortened time to first intravenous antibiotics, with median reductions of 2077 minutes versus usual care and 1-hour antibiotic compliance increase. Completion of bundle elements such as lactate measurement and initial fluid bolus improved, with gains of 2030 percentage points. Overall ICU admission rates were largely unchanged, although some studies reported more timely direct ICU transfer. Mortality effects were heterogeneous; several studies showed in-hospital mortality reductions of 411 percentage points, whereas others reported no significant difference.
Conclusions:
Across emergency care settings, integrated sepsis detection protocols improved timeliness and completeness of early sepsis management and may reduce mortality when linked to effective response pathways. These findings support local adaptation and implementation of integrated protocols as a component of sepsis quality-improvement initiatives in emergency departments.