Indigenous Patients with Community Acquired Septic Shock Receive the Same Standard of Care as Non-Indigenous Patients in the Top End of Northern Territory, Australia

Introduction: Indigenous people have a fourfold higher incidence of sepsis in the Top End of the Northern Territory, Australia. However, their mortality from sepsis is not higher, despite an overall lower life expectancy, poorer access to healthcare, remoteness, higher chronic disease burden and social disadvantage. This suggests that Indigenous patients with sepsis receive the same standard of care as non-Indigenous patients; however, this has not been confirmed by investigation. The objective of the present study was to compare the early management of community acquired septic shock between Indigenous and Nonindigenous patients at the Royal Darwin Hospital (RDH) in the Top Endof the Northern Territory, Australia.

Methods: Retrospective case note review of adult patients with septic shock admitted via the Emergency department (ED) of RDH between 01/01/2004 to 01/08/2005. Comparisons between Indigenous and Non-indigenous patients with septic shock were made with respect to: time to antibiotic, fluid resuscitation, time spent in the ED, mechanical ventilation, vasopressor use, continuous renal replacement therapy (CRRT), source control, Intensive Care Unit (ICU) length of stay (LOS), hospital LOS, and mortality.

Results: One hundred and twenty patients were included (69 Indigenous). Indigenous patients were younger, 46 (14) vs 54 (17) (p=0.004), with a higher chronic disease burden and similar Acute Physiology and Chronic Health Evaluation (APACHE) II scores, 20.1 (7.9) vs 20.7 (7.8). Indigenous patients had significantly higher rates of aeromedical retrieval, lower rates of self presentation (p<0.05), and a trend to more hypotension on arrival (p=0.08); suggesting that they had a delayed presentation compared with Non-indigenous patients. There were no significant differences in time to antibiotic, fluid resuscitation, time spent in the ED, mechanical ventilation, need for vasopressors, CRRT, source control, ICULOS, hospital LOS, and mortality. Another important finding was the positive culture rate from blood culturestaken after antibiotic administration was not significantly lower than thepositive rate for blood cultures taken prior to antibiotic.

Conclusions: Management of community acquired septic shock in the Top End of Australia does not appear to differ between Indigenous and Non-indigenous patients; including compliance with surviving sepsis guidelines, antibiotic therapy, intensive care therapies and source control. While this is encouraging, the contributing factors leading to a higher burden of sepsis and septic shock in Indigenous people in the Top End needs further investigation. The study’s findings also support the taking of blood cultures in septic shock, even if antibiotics have already been administered.