<b>Early Recognition and Management of Sepsis in the Emergency Department of a Tertiary Care Hospital</b>

Background: Sepsis is a leading cause of preventable morbidity and mortality worldwide, disproportionately affecting patients in low- and middle-income countries. Early recognition and adherence to evidence-based management protocols in the emergency department are critical for improving outcomes. Objective: To evaluate recognition and management of sepsis in the emergency department of Lady Reading Hospital, Peshawar, and to determine their association with patient outcomes. Methods: This prospective observational study enrolled 210 adult patients meeting Sepsis-3 criteria between June and September 2024. Demographic, clinical, laboratory, and management data were collected prospectively. Outcomes included ICU admission, hospital length of stay, and in-hospital mortality. Statistical analyses included chi-square tests, t tests, and multivariable logistic regression to identify independent predictors of mortality. Results: The mean age was 51.7 ± 17.6 years, with 58.1% male patients. Pneumonia (34.3%) was the most common infection source. Sepsis was recognized at triage in 61.4%, antibiotics were administered within one hour in 46.2%, and the complete SSC Hour-1 bundle was achieved in 38.6%. In-hospital mortality was 28.1%. Timely antibiotics reduced odds of death by 56% (adjusted OR 0.44, 95% CI 0.23–0.82, p=0.01), while delayed antibiotics and incomplete bundle adherence were independent predictors of mortality. Conclusion: Early recognition, prompt antibiotics, and full Hour-1 bundle adherence significantly improve survival in sepsis. Strengthening triage protocols, rapid antibiotic delivery, and staff training are essential for reducing sepsis-related mortality in resource-limited emergency departments.