Examining Trends in Sepsis and Sepsis Management by Non-Physician Clinicians in a Rural Ugandan Emergency Department Over a Decade.

Background: There is a paucity of data from Sub-Saharan Africa regarding sepsis outcomes and the impact of sepsis care on those outcomes, including the impact of care provided by non-physician clinicians (NPCs). Methods: Data were retrospectively analyzed from a rural Ugandan emergency department staffed by NPCs using a quality assurance database of adult and pediatric patient visits with and without sepsis from 2010 through 2018. Sepsis was defined as suspected infection with a qSOFA score ≥ 2. Mortality, disposition, and NPC adherence to intravenous fluid and anti-infective therapy were analyzed using chi-squared and multivariable linear regression. Results: Sepsis criteria were met in 4,847 (11.0%) cases. Sepsis cases compared to non-sepsis cases were significantly older, and had higher rates of comorbid malaria, HIV, tuberculosis, and pneumonia. They had higher admission rates (86.8% versus 66.3%), were more likely to still be admitted at three days (40.2% versus 26.2%), and had higher mortality at three days (7.8% versus 2.5%). The incidence of sepsis significantly declined over time from 16.3% in 2010 to 3.1% in 2018 while the proportion of sepsis cases with qSOFA score of ≥ 3 increased significantly over time. The decrease in incidence was largely due to a precipitous drop in malaria smear-positive sepsis. Utilizing a multivariable linear regression model, annual three-day sepsis mortality did not significantly change over time, though adherence to administration of both fluids and anti-infectives increased significantly from 12.3% in 2010 to 35.0% in 2018. Conclusions: Sepsis incidence, especially malaria smear-positive sepsis, decreased over time, while annual mortality did not change despite increased adherence to administration of anti-infectives and intravenous fluids in an NPC-staffed emergency department. Further studies are needed to investigate the contextualized use of anti-infectives and fluid resuscitation.