Abstract / Summary
Abstract Purpose Sepsis often presents with non-specific symptoms that delay diagnosis and treatment. This study characterized pre-hospital outpatient and emergency care among patients with community-acquired sepsis (CAS) in Germany prior to hospitalization. Methods This population-based observational cohort study used de-identified health claims data from over 340,000 AOK-insured adults admitted to hospital between 2016 and 2019 with an ICD-10-GM code for sepsis plus organ dysfunction, with each patient contributing only their first qualifying hospitalization (index case). Patients without ICD-10-GM codes for and suggestive of nosocomial infection were included and their healthcare utilization in the week before admission was categorized into: hospital emergency care (HEC), outpatient care only (OC), or no healthcare utilization (no HCU) (excluding patients exclusively hospitalized in the week prior sepsis hospitalization). Treatment and patient characteristics, sepsis features, and outcomes as documented in health claims data were compared across groups using descriptive and non-parametric statistics. Results Among 238,247 patients identified with CAS, 12.7% received HEC, 61.8% OC, and 25.5% had no HCU. HEC patients were younger, more severely ill, with higher ICU admission and mortality rates compared to the other groups. In the OC group, most patients (82.3%) had encounters with general practitioners, and 45.1% received OC on the day of admission. The last infection-related encounter occurred on average 2.0 days (SD 2.3) prior to sepsis hospitalization. Among OC patients, 48.7% underwent infection-related laboratory diagnostics, and 11.4% received anti-infective prescriptions. Conclusion Most patients with CAS had healthcare contact in the week prior to hospitalization, predominantly in outpatient care. The frequent encounters shortly before admission and low rates of anti-infective prescription may suggest opportunities for earlier recognition and better risk stratification, e.g. by strengthening sepsis awareness and diagnostic strategies in outpatient settings. Trial Registration The study was pre-registered in the German Clinical Trials Register (DRKS00031302) on 05/05/2023.