Placement of central venous lines for sepsis in the elderly has markedly increased—Evidence from a cohort of New Jersey (USA) emergency departments
Brandon Close1, Peter Richman1, Barnet Eskin2, John R. Allegra2
1Christus Spohn/Texas A&M School of Medicine, Corpus Christi, TX, USA
2Morristown Medical Center, Morristown NJ and Emergency Medical Associates Research Foundation, Parsippany, NJ, USA
Keywords: Central line, Sepsis
Background: Early goal directed therapy for sepsis patients requires placement of central lines (CVPL) to measure central pressure.
Objective: We hypothesized that the percentage of CVPL placed for sepsis has increased over time, whereas the frequency of lines placed for other conditions has not changed.
Methods: This was a retrospective cohort study. Investigators analyzed records from consecutive ED patients in nine hospitals over a 10-year period. Patients >65 years identified with CVPL by CPT codes and diagnoses established by ICD-9 codes.
We computed the annual number of patients that had a CVPL placed for sepsis and other conditions. We calculated the change from 2005 and 2014 in the normalized number of patients >65 with sepsis and other conditions and the 95% confidence intervals (CIs).
We normalized the annual number of CVPLs by the average number of total annual visits for those >65 years as the annual visits in the >65 years cohort increased by > 25% over the course of the study. We then plotted the annual number of normalized CVPLs for sepsis and other conditions placed versus year and computed the linear regression coefficients (R2). Alpha was set at 0.05.
Results: Of the 3,772520 visits in the data base there were 711,435 visits by patients >65 years; 3184 (0.45%) had CVPL placed and 784 of those patients were treated for sepsis. The percent of patients with CVPL for sepsis increased 212% (95% CI: 115% to 356%) from 2005 to 2014, but there was no statistically significant annual change in percent of CVPL placed for other conditions (10% decrease, 95% CI: −26% to 9%). The linear regression coefficient for the plot of annual normalized number of CVPLs vs. year (See table and plot) was statistically significant for sepsis (R2 = 0.94, p < 0.001) but not for other conditions (R2 = 0.09, p = 0.80).
Conclusion: We found that CVPL placed for sepsis tripled from 2004 to 2011, whereas CVPL placed for other conditions did not change significantly.