Initial management of septic complications in adult oncologic patients in the emergency department: A systematic review and meta-analysis

Background and aims: Cancer encompasses a group of diseases that progressively affect an increasing number of individuals. This condition elevates the risk of developing sepsis in these patients, requiring care in the emergency department. Therefore, this review aims to evaluate whether the initial management of septic complications in emergency departments adheres to current recommendations and enhances patient survival. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a systematic review with meta-analysis was conducted using searches in PubMed, Scopus, Web of Science and BVS Library databases. Studies evaluating oncology patients with sepsis in the emergency department were selected. Additionally, a random-effects meta-analysis was performed assessing time to antibiotics due to the implementation of protocols. The Joanna Briggs Institute tools were used to assess the risk of bias for each type of study included. Results: The searches yielded 1040 results. After removing duplicates and filtering by title and abstract, 16 studies were selected for qualitative synthesis and 5 studies were selected for quantitative synthesis. Overall, the times from arrival at the emergency department to initial care did not meet established standards, which were associated with higher mortality rates. However, meta-analysis showed a reduction of 10.16 minutes on time to antibiotics due to the implementation of protocols. The most common infection sites were the urinary, digestive and respiratory tracts, with the latter 2 presenting the highest mortality rates. However, the use of scales and the implementation of specialized clinical staff help mitigate these problems. Conclusion: The management of septic complications does not comply with current regulations, highlighting the need for systematic protocols to improve care times. Implementation of protocols and early detection of complications through standardized scales and advanced clinical staff is essential to optimize care. Further research focused on these patients is needed to evaluate the effectiveness of interventions guided by expert personnel and specific scales.