---
title: "Evaluating Community-Acquired Acute Infections in Irish Emergency Departments"
id: "plos-one-2-assessing-community-acquired-acute-infection-in-an-irish-emergency-department-a"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-2-assessing-community-acquired-acute-infection-in-an-irish-emergency-department-a"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954"
published_at: "2026-10-05T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Evaluating Community-Acquired Acute Infections in Irish Emergency Departments
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-2-assessing-community-acquired-acute-infection-in-an-irish-emergency-department-a
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954)
- **Published At:** 2026-10-05T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- **Sepsis** is a critical condition with high morbidity and mortality, predominantly community-acquired in Ireland. - The study will take place at **Mater Misericordiae University Hospital** in Dublin, focusing on adult ED presentations. - It aims to identify community-acquired acute infections through manual review of clinical records. - Data will encompass demographic details, referral pathways, clinical presentation, and outcomes. - **Multivariable logistic regression** will analyze factors linked to adverse outcomes like ICU admission or mortality. - Existing datasets fail to capture many patients, especially those with severe infections who die in the ED or are directly discharged. - Study objectives include characterizing presentations, estimating the volume of community-acquired cases, and assessing referral patterns. - Data collection will occur during predefined 24-hour sampling periods throughout 2025, ensuring seasonal representation. - Findings aim to enhance early **sepsis** recognition and improve emergency care resource planning.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0359954) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#citedHeader) * 0 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954#discussedHeader) Open Access Study Protocol # Assessing community-acquired acute infection in an irish emergency department: A retrospective observational study protocol * Nandakumar Ravichandran , Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing * E-mail: Nandakumar.ravichandran@ucd.ie Affiliations School of Medicine, University College Dublin, Dublin, Ireland, Mater Misericordiae University Hospital, Dublin, Ireland [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0001-1199-6793 ](https://orcid.org/0009-0001-1199-6793 "ORCID Registry") ⨯ * Etimbuk Umana, Roles Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing Affiliations School of Medicine, University College Dublin, Dublin, Ireland, Mater Misericordiae University Hospital, Dublin, Ireland [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0780-8614 ](https://orcid.org/0000-0002-0780-8614 "ORCID Registry") ⨯ * Tomas Breslin, Roles Investigation, Project administration, Resources, Supervision, Validation, Writing – original draft, Writing – review & editing Affiliations School of Medicine, University College Dublin, Dublin, Ireland, Mater Misericordiae University Hospital, Dublin, Ireland ⨯ * Aoife Cotter, Roles Funding acquisition, Investigation, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing Affiliations School of Medicine, University College Dublin, Dublin, Ireland, Mater Misericordiae University Hospital, Dublin, Ireland ⨯ * Walter Cullen Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing Affiliation School of Medicine, University College Dublin, Dublin, Ireland ⨯ # Assessing community-acquired acute infection in an irish emergency department: A retrospective observational study protocol * Nandakumar Ravichandran, * Etimbuk Umana, * Tomas Breslin, * Aoife Cotter, * Walter Cullen ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: October 5, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0359954) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0359954) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0359954) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0359954) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#sec001) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#sec003) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#sec013) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0359954) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954) ## Abstract Sepsis is a life-threatening condition associated with substantial morbidity and mortality worldwide. In Ireland, the majority of sepsis cases are community-acquired; however, patients presenting to emergency departments (EDs) with suspected severe infection remain poorly characterised, particularly those not captured in administrative datasets. This retrospective cross-sectional observational study will be conducted in the ED of Mater Misericordiae University Hospital, Dublin. Adult (non-maternity) ED presentations across eight predefined 24-hour sampling periods will be reviewed. Community-acquired acute infection will be identified through manual review of ED clinical documentation, and possible sepsis will be identified using the ED triage sepsis discriminator supported by clinical documentation. Data collected will include demographic characteristics, referral pathways, clinical presentation, and patient outcomes. Multivariable logistic regression will be used to identify factors associated with adverse outcomes, defined as intensive care unit admission or in-hospital mortality. This study will provide a detailed evaluation of ED presentations with suspected severe infection in Ireland, including patients not captured in existing national datasets. Findings will contribute to improved understanding of early sepsis recognition, referral pathways, and resource planning in emergency care. ## Figures ![](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t001) ![](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t001) ![](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t002) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t001) **Citation:** Ravichandran N, Umana E, Breslin T, Cotter A, Cullen W (2026) Assessing community-acquired acute infection in an irish emergency department: A retrospective observational study protocol. PLoS One 21(10): e0359954. https://doi.org/10.1371/journal.pone.0359954 **Editor:** Ramya Iyadurai, Christian Medical College Vellore, INDIA **Received:** April 15, 2026; **Accepted:** September 20, 2026; **Published:** October 5, 2026 **Copyright:** © 2026 Ravichandran et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion without compromising participant confidentiality. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref001)]. It represents a time-critical medical emergency, yet it remains difficult to recognise, particularly in primary care settings. Without prompt detection and management, sepsis can rapidly progress to tissue damage and multi-organ failure. According to the National Sepsis Report (2023), sepsis and septic shock were documented in 14,535 non-maternity adult patients in Ireland, with a mortality rate of 20.6% (2). Community-acquired sepsis represents a substantial public health burden, with over 70% of all sepsis cases originating in the community rather than hospitals [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref002)–[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref004)]. A recent Irish study examining sepsis between 2016 and 2022 identified 86,011 community-acquired sepsis (85.2%) and 14,930 hospital-acquired (14.8%) episodes, with hospital-acquired sepsis defined as infection onset occurring at least two days after admission [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref005)]. Socioeconomic disparities were evident, with patients from lower socioeconomic backgrounds demonstrating a 20% higher likelihood of death. General practitioners (GPs), GP-out-of-hours services, paramedics, and community healthcare professionals are often the first point of contact for patients with severe infection [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref006)]. Irish general practice facilitates over 29 million consultations annually, in addition to alongside approximately 1.5 million out-of-hours consultations [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref007)], placing these services at the forefront of early sepsis recognition and escalation. Analysis of Hospital In-Patient Enquiry (HIPE) data (2020–2024) identified 68,644 sepsis admissions, of which 62.0% were community-acquired. However, HIPE data capture only admitted patients and therefore do not reflect the early trajectory of disease at emergency department (ED) presentation. Patients presenting to ED with community-acquired acute infection remain poorly characterised in Irish research. Existing datasets do not capture patients who die in the ED prior to admission, near-miss cases treated and discharged, referral pathways (GP, OOH, paramedic, self-referral) and early physiological markers at presentation. Understanding these factors is essential to improve early detection, optimise resource allocation, and enhance patient outcomes. This study aims to characterise patients presenting to an Irish emergency department with community-acquired acute infection and to evaluate factors associated with adverse clinical outcomes. ### Study objectives The primary objective of the study is to characterise patients presenting to the emergency department with community-acquired acute infection across eight predefined sampling periods. The secondary objectives of the study are: * To estimate the proportion of ED presentations attributable to community-acquired acute infection. * To describe patterns of referral from general practice, GP out-of-hours services, paramedics, and self-presentation. * To compare clinical presentations and source of referrals between weekday and weekend admissions. * To determine the frequency of possible sepsis and identify factors associated with possible sepsis and adverse clinical outcomes. ## Methods ### Study design and setting This study is a single-centre retrospective observational study of presentations to the emergency department of Mater Misericordiae University Hospital (MMUH), Dublin. The study used a cross-sectional approach to identify all presentations with community-acquired acute infection and an observational analytical component to examine factors associated with possible sepsis and clinical outcomes. MMUH is a large tertiary-level teaching hospital in Dublin with a high-volume urban emergency department that receives referrals from primary care, ambulance services, and self-presenting patients. It provides care to a predominantly adult population (aged ≥16 years) and does not provide maternity services. The hospital serves an urban catchment area with a significant proportion of socioeconomically deprived communities [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone.0359954.ref008)]. The study protocol and findings of the study will be reported in adherence to the recognised principles of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and RECORD (REporting of studies Conducted using Observational Routinely-collected health Data) statements. ### Sample size To account for potential seasonal variation in infection patterns (e.g., winter respiratory surges), data will be collected from predefined 24-hour sampling periods across the year 2025: Winter – January 14th (Tue) & Jan 19th (Sun); Spring - April 14th (Mon) & Apr 20th (Easter Sun); Summer – July 14th (Mon) & July 20th (Sun); Autumn: October 14th (Tue) & Oct 19th (Sun). Sampling across both weekday and weekend periods is intended to improve representativeness while maintaining feasibility for detailed manual chart review. No formal sample size calculation was performed because all eligible presentations occurring during the predefined sampling periods were included. The study therefore represents a census of all eligible presentations rather than a sampled cohort. ### Inclusion criteria All ED presentations during the predefined sampling periods will be screened. Patients meeting the case definition for community-acquired acute infection will form the study group. Total ED presentations will be used as the denominator to estimate the proportion of community-acquired infection presentations. ### Case Definition Community-acquired acute infection was defined as documented clinical suspicion or diagnosis of infection recorded in ED triage documentation or emergency physician notes following manual review of the clinical record. Possible sepsis was defined as presentations in which the ED triage sepsis discriminator identified concern for sepsis, supported by documentation within the ED clinical record. ### Exclusion criteria * Hospital-acquired infections developing ≥48 hours after hospital admission or clearly documented as hospital acquired were excluded. Community-acquired infection referred to infection present at, or before, emergency department presentation. ### Data collection and variables extracted [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t002)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0359954.t002 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0359954.t002) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0359954.t002) [ https://doi.org/10.1371/journal.pone.0359954.t002](https://doi.org/10.1371/journal.pone.0359954.t002) Data will be extracted using a case report form ([Table 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0359954#pone-0359954-t001)). Data collection is scheduled to begin in mid-May 2026 and will continue until December 2026. The study results are expected to be available in February 2027. Eligibility and data extraction will be independently undertaken by two reviewers using a standardised data collection form. Discrepancies will be resolved by discussion and consensus with a third reviewer. [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0359954.t001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0359954.t001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0359954.t001) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0359954.t001) Table 1. Case report form. [ https://doi.org/10.1371/journal.pone.0359954.t001](https://doi.org/10.1371/journal.pone.0359954.t001) ### Outcome measures The primary outcomes measured are characteristics of possible sepsis presentations and referral pathways of community-acquired acute infections. The secondary outcomes include 30-day and 90-day mortality, hospital admission rate, sepsis pathway activation and referral sources. ### Data analysis Statistical analysis will be performed using SPSS and Python notebook. Descriptive statistics will be used to summarise patient characteristics, referral pathways, and clinical outcomes. Categorical variables will be presented as frequencies and proportions, while continuous variables will be summarised using means with standard deviations or medians with interquartile ranges, depending on distribution. Associations between referral source and adverse outcomes will initially be explored using chi-square tests. Variables (age, sex, NEWS score, vital signs, C-Reactive Protein) associated with possible sepsis in univariable analyses together with clinically relevant covariates will be entered into an exploratory multivariable logistic regression model. Statistical significance will be set at p < 0.05. Missing data were reported for individual variables. Analyses were performed using complete-case analysis for each variable, with no imputation of missing values. ### Ethical considerations Ethical approval was obtained from the Mater Misericordiae University Hospital (MMUH) Research Ethics Committee (REC Ref: 1/378/2584TMR). This study involves a retrospective review of existing clinical records only. Data will be extracted from patient records by authorised members of the research team (NR, EU, TB, AC), who may have access to identifiable information during the data collection process. However, no patient or clinician identifiers will be recorded in the study dataset. Data will be pseudonymised prior to analysis and stored in a secure format, with access restricted to authorised members of the research team. Mater Misericordiae University Hospital will act as the data controller, and all data will be stored and analysed within the institution. All electronic data will be maintained on encrypted, password-protected systems in compliance with GDPR regulations. As t
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