# Prevalence, treatment, and outcomes of sepsis during rapid response team calls: A systematic review and meta-analysis

## TL;DR

Sepsis is responsible for about a quarter of rapid response team calls in hospitals, with significant mortality and resource use, highlighting the need for better protocols.

## Contribution

This study provides the first comprehensive meta-analysis of sepsis prevalence and outcomes during rapid response team calls.

## Key findings

- Sepsis accounts for 23.7% of rapid response team calls, with no significant difference between exclusive and mixed cause studies.
- Hospital mortality for sepsis-related calls is 12.9%, with an average length of stay of 18 days.
- Antibiotic changes were initiated in 38.8% of sepsis-related rapid response team events.

## Abstract

Sepsis is a leading cause of morbidity and mortality in hospitalised patients. Rapid Response Teams (RRTs) review clinically deteriorating patients, including those with sepsis. However, the epidemiology of sepsis in RRT calls remains unclear. This systematic review synthesised evidence on the prevalence, treatment, and outcomes of sepsis during RRT calls.

Seven electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, Ovid MEDLINE, and Scopus) were searched for studies published from 1 January 2015 to 31 May 2024. All articles were independently screened and assessed for study quality using the Newcastle Ottawa Scale by two reviewers per article. The primary outcome was the prevalence of sepsis during RRT calls. Secondary outcomes included hospital mortality and length of hospitalisation. Data were pooled using random-effects meta-analyses.

From 5632 studies screened, 26 studies encompassing 110,909 patients and 139,076 RRT events were included. The pooled mean age was 64.4 years (95%CI: 59.2–69.7) and 48.4 % (n = 51,720, 24 studies) were male. The pooled prevalence of sepsis among all RRT calls was 23.7 % (95%CI: 15.5 %–34.6 %), with no significant difference between studies including exclusively sepsis RRT calls and studies with all causes of RRT calls (32.7 % vs. 21.8 %; p = 0.16). Common sepsis-related RRT triggers included abnormal respiratory and heart rates. Overall hospital mortality was 12.9 % (95%CI: 7.3–21.7 %) and hospital length of stay was 18 days (95%CI: 13.9–22.1), both showing no significant differences between studies including exclusively sepsis RRT calls and studies with all causes of RRT calls. New or changes in antibiotics were initiated in 38.8 % of sepsis-related RRTs. Most patients remained on the ward, while 23.3 % were transferred to the ICU.

Sepsis is a trigger for a quarter of RRT calls, associated with substantial resource use and mortality in one eighth of patients. These findings support the need for standardised recognition protocols, escalation guidelines and prospective trials to optimise outcomes.