effect of out-of-hour admission on fluid treatment of emergency department patients with suspected infection; a multicenter post-hoc analysis

Introduction: sepsis is a life-threatening and common cause of emergency department (ed) referrals. out-of-hour staffing is limited in ed, which may potentially affect fluid administration. this study aimed to investigate fluid volume variation in out-of-hour vs. routine-hour admissions. methods: the present study is a post-hoc analysis of a multicentre, prospective, observational study investigating fluid administration in ed patients with suspected infection, from jan 20th - march 2nd, 2020. patient groups were “routine-hours” (rh): weekdays 07:00-18:59 or “out-of-hours” (ooh): weekdays 19:00-06:59 or friday 19:00-monday 06:59. primary outcome was 24-hour total fluid volumes (oral + intravenous (iv)). secondary outcomes were total fluids 0-6 hours, oral fluids 0-6 and 0-24 hours, and iv fluids 0-6 and 0-24 hours. linear regression adjusted for site and illness severity was used. results: 734 patients had suspected infection; 449 were admitted during rh and 287 during ooh. mean (95% ci) total 24-hour fluid volumes were equal in simple infection and sepsis regardless of admission time: simple infection rh: 3640 (3410 - 3871) ml and ooh: 3681 (3451 - 3913) ml. sepsis rh: 3671 (3443;3898) ml and ooh: 3896 (3542;4250) ml. oral fluids 0-6h were reduced in simple infection and sepsis among ooh vs. rh. sepsis patients received more 0-6-hour iv fluid when admitted ooh vs. rh. there were no associations between admission time and 0-24-hour oral or iv volumes in simple infection or sepsis. conclusion: admission time did not have an association with 24-hour total fluid volumes. sepsis patients admitted during ooh received more 0-6-hour iv fluids than rh patients, and simple infection and sepsis patients received less oral fluid in 0-6 hours if admitted during ooh vs. rh.