120 An Emergency Medical Services Sepsis Protocol With Point-of-Care Lactate Accurately Identifies Out-of-Hospital Patients With Severe Infection and Sepsis

Shiuh, T.; Sweeney, Timothy E.; Rupp, RN Valerie; Davis, Billie S.; Reed, J Jude

doi:10.1016/j.annemergmed.2012.06.097

Cited by 3 publications

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“…Three studies were published in abstract form only. 20 27 28 Studies originate from five countries, comprising a total of 147 320 patients. All studies were published in English.…”

Section: Resultsmentioning

confidence: 99%

“… 29–31 Six studies addressed the identification of sepsis within EMS. 12 15 20 21 27 28 Collectively, six prehospital screening tools were identified in the course of the review (critical illness score, 32 Prehospital Recognition of Severe Sepsis (PRESS) score, 31 Prehospital Early Sepsis Detection (PRESEP) score, 30 Robson tool, 21 30 modified Robson tool 15 and BAS 90-30-90 21 30 ); a single study reported the accuracy of the Modified Early Warning Score (MEWS). 30 None of the studies were prospective and no studies were designed specifically to validate a prehospital sepsis screening tool in clinical practice.…”

Section: Resultsmentioning

confidence: 99%

“…We identified very low-quality evidence (downgraded for risk of bias, indirectness, imprecision and abstract only publication), from three observational studies, 20 27 28 addressing accuracy of paramedic diagnosis of sepsis in clinical practice (see table 2 ). All three studies were published in abstract and it is not clear if paramedics used a screening tool or if they received any training to improve sepsis recognition.…”

Section: Resultsmentioning

confidence: 99%

“…In the study by Shiuh et al , 27 EMS crews stratified patients with sepsis according to prehospital lactate readings. If patients had a lactate >4 mmol/L, paramedic crews provided the hospital with an ‘alert’ message, whereas if the lactate was in the range of 2.5–3.9 mmol/L, they provided the hospital with an ‘inform’ message prior to, or on, hospital arrival.…”

Section: Resultsmentioning

confidence: 99%

“…Although nine studies were identified in the course of this review, only five were concerned with screening of patients in clinical practice by EMS clinicians. 12 15 20 27 28 These studies enrolled a total of 1123 patients, over half of whom (675) were in the Travers et al 28 study. Given the very limited number of participants in the remaining studies (range 49–183), it is unlikely that reported point estimates are sufficiently precise to draw conclusions with confidence.…”

Section: Discussionmentioning

confidence: 99%

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Identification of adults with sepsis in the prehospital environment: a systematic review

2016

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ObjectiveEarly identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition.DesignSystematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted.SettingPrehospital/emergency medical services (EMS).Study selectionAll studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS.Outcome measuresRecognition of sepsis by EMS clinicians.ResultsOwing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool.ConclusionsRecognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit.

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“…Three studies were published in abstract form only. 20 27 28 Studies originate from five countries, comprising a total of 147 320 patients. All studies were published in English.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Identification of adults with sepsis in the prehospital environment: a systematic review

2016

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Derivation and internal validation of the screening to enhance prehospital identification of sepsis (SEPSIS) score in adults on arrival at the emergency department

Smyth

Gallacher

Kimani

et al. 2019

Scand J Trauma Resusc Emerg Med

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Background Prehospital recognition of sepsis may inform case management by ambulance clinicians, as well as inform transport decisions. The objective of this study was to develop a prehospital sepsis screening tool for use by ambulance clinicians. Methods We derived and validated a sepsis screening tool, utilising univariable logistic regression models to identify predictors for inclusion, and multivariable logistic regression to generate the SEPSIS score. We utilised a retrospective cohort of adult patients transported by ambulance ( n = 38483) to hospital between 01 July 2013 and 30 June 2014. Records were linked using LinkPlus® software. Successful linkage was achieved in 33289 cases (86%). Eligible patients included adult, non-trauma, non-mental health, non-cardiac arrest cases. Of 33289 linked cases, 22945 cases were eligible. Eligible cases were divided into derivation ( n = 16063, 70%) and validation ( n = 6882, 30%) cohorts. The primary outcome measure was high risk of severe illness or death from sepsis, as defined by the National Institute for Health and Care Excellence Sepsis guideline. Results ‘High risk of severe illness or death from sepsis’ was present in 3.7% of derivation ( n = 593) and validation ( n = 254) cohorts. The SEPSIS score comprises the following variables: age, respiratory rate, peripheral oxygen saturations, heart rate, systolic blood pressure, temperature and level of consciousness ( p < 0.001 for all variables). Area under the curve was 0.87 (95%CI 0.85–0.88) for the derivation cohort, and 0.86 (95%CI 0.84–0.88) for the validation cohort. In an undifferentiated adult medical population, for a SEPSIS score ≥ 5, sensitivity was 0.37 (0.31–0.44), specificity was 0.96 (0.96–0.97), positive predictive value was 0.27 (0.23–0.32), negative predictive value was 0.97 (0.96–0.97), positive likelihood value was 13.5 (9.7–18.73) and the negative likelihood value was 0.83 (0.78–0.88). Conclusion This is the first screening tool developed to identify NICE high risk of severe illness or death from sepsis. The SEPSIS score is significantly associated with high risk of severe illness or death from sepsis on arrival at the Emergency Department. It may assist ambulance clinicians to identify those patients with sepsis in need of antibiotic therapy. However, it requires external validation, in clinical practice by ambulance clinicians, in an independent population. Electronic supplementary material The online version of this article (10.1186/s13049-019-0642-2) contains supplementary material, which is available to authorized users.

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Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature

Kirby

2013

Journal of Paramedic Practice

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Sepsis is increasingly common and has a high mortality rate. Sepsis can be difficult to identify and patients with severe sepsis often initially present to the ambulance service. Lactate testing has been utilised successfully in other healthcare settings to assist with the identification of septic patients and stratification of illness severity. A focused literature review has revealed that pre-hospital lactate testing has shown benefits to clinicians pre-hospitally in the identification of septic patients presenting to the ambulance service. Only four pieces of primary research were identified and small sample sizes and variability of lactate testing limit the generalisation of the findings. Further research is required to fully investigate the potential benefits of using pre-hospital lactate testing to identify those patients with sepsis, severe sepsis and septic shock presenting to the ambulance service.

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120 An Emergency Medical Services Sepsis Protocol With Point-of-Care Lactate Accurately Identifies Out-of-Hospital Patients With Severe Infection and Sepsis

Cited by 3 publications

References 0 publications

Identification of adults with sepsis in the prehospital environment: a systematic review

Identification of adults with sepsis in the prehospital environment: a systematic review

Derivation and internal validation of the screening to enhance prehospital identification of sepsis (SEPSIS) score in adults on arrival at the emergency department

Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature

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