Internal Medicine · Infectious Disease · 2 h ago
Diagnostic disagreement linked to mortality in culture-positive septic shock
A multicenter retrospective cohort study of 2,233 patients with septic shock found that early disagreement among clinicians about shock etiology was associated with higher ICU mortality in patients with positive blood cultures. The association was not explained by differences in the timing of antibiotics, fluids, or vasopressors.
- Disagreement occurred in 9.5% of the cohort.
- The mortality association was observed in culture-positive patients.
- Treatment timing did not explain the observed association.
- Retrospective findings do not establish causation.
Researchers analyzed records from 2,233 adults with Sepsis-3 septic shock treated at eight acute-care hospitals between 2018 and 2023. They compared clinicians’ documented assessments of shock etiology during the first 48 hours in the ICU; disagreement was defined by a cosine similarity score below 1. Adjusted analyses assessed ICU mortality and whether timing of antibiotics, fluid boluses, or vasopressors mediated any association.
Disagreement was identified in 213 patients (9.5%), occurring more often at the academic center than at community sites (13.3% vs 7.2%; p<0.001). The relationship with mortality varied by blood-culture status. Among culture-positive patients, disagreement was associated with a 16.9-percentage-point higher adjusted mortality risk (95% CI, 1.1–32.7; p=0.036). The subgroup estimate for adjusted odds was 1.99 (95% CI, 0.98–4.01; p=0.056). Disagreement was not associated with different rates or timing of the treatments examined in this subgroup.
The findings suggest that diagnostic disagreement may mark higher risk in culture-positive septic shock, but do not establish that disagreement causes worse outcomes. The retrospective design and subgroup uncertainty limit interpretation; the study does not show that changing treatment based on disagreement improves survival. Funding came from the Agency for Healthcare Research and Quality.
In practice
In patients with Sepsis-3 septic shock and positive blood cultures, early disagreement among clinicians about shock etiology was associated with higher adjusted mortality risk in this retrospective cohort. This may identify a higher-risk clinical context, but the study does not establish that disagreement causes mortality or that a particular response to disagreement improves outcomes. The association was not explained by measured timing of antibiotics, fluids, or vasopressors, and the subgroup odds estimate was imprecise. These findings alone do not support a change in treatment protocols.
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Critical Care: Association of inter-clinician diagnostic disagreement with increased mortality among patients with septic shock: a retrospective cohort study ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.