Prediction of Serious Infection During Prehospital Emergency Care

Suffoletto, Brian; Frisch, Adam; Prabhu, Arjun; Kristan, Jeffrey; Guyette, Francis X.; Callaway, Clifton W.

doi:10.3109/10903127.2011.561411

“…Still, a brief patient history combined with a simple primary survey of clinical parameters should enable the EMS staff to recognize most of the critically ill patients with sepsis. 12 It is possible that EMS personnel and GPs did recognize sepsis but failed to document it, as we only assessed the data derived from electronic or paper records. Valuable information may have been given verbally to the ED staff without EMS personnel seeing the need for proper documentation.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands

Wekken¹,

Alam²,

Holleman³

et al. 2015

Prehospital Emergency Care

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Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. We conducted a retrospective cohort study using transport information from EMS Amsterdam and admission diagnoses at the emergency department gathered through discharge data from two academic hospitals in Amsterdam for the year 2012. A total of 253 patients with sepsis were evaluated, of which 131 were transported by ambulance. The in-hospital mortality rate of the total population was 21% and a mean length of hospital stay was of 13.5 days. Sixty-seven patients (26.5%) were admitted to the intensive care unit. Almost half of the patients were assigned to the internal medicine ward (117; 46.2%). The most common site of infection was the urinary tract (30%). E. coli was the most frequent cause of infections. EMS staff recognized 18/131 (13.7%) transported patients with (severe) sepsis or septic shock. In 52 cases (39.7%) sepsis went unrecognized, probably due to an incomplete primary survey. In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness.

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“…We observed that many EMS encounters hospitalized with severe sepsis were transported by basic life support providers, classified as "nonurgent," and did not receive pre-hospital intravenous access-even though the vast majority were diagnosed on hospital admission. This occurred on a backdrop of thousands of low-risk EMS encounters, among whom 40% were not transported to hospitals and 70% brought to hospitals were discharged from the emergency (12,19), highlights an urgent need for accurate recognition tools for severe sepsis. Although no "12-lead ECG" is available, biological platforms that include traditional biomarkers or molecular expression profiles may complement existing clinical tools to assist in sepsis case finding.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, no similar care coordination or pre-hospital management is widely adopted in severe sepsis. The uncertain burden of pre-hospital sepsis, difficulty in rapid diagnosis, and variable pre-hospital care and times are barriers to shifting the paradigm of sepsis care from the emergency department to the ambulance gurney (13,19).…”

mentioning

confidence: 99%

Severe Sepsis In Prehospital Emergency Care: Analysis Of Incidence, Care, And Outcome

Seymour

¹

,

Rea

²

,

Kahn

³

et al. 2012

A24. Clinical Sepsis

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Rationale: Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care systempre-hospital emergency care-is unknown. Objectives: We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke. Methods: Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital. Measurements and Main Results: Overall incidence rate of hospitalization with severe sepsis among EMS encounters, as well as pre-hospital characteristics, admission diagnosis, and outcomes. Among 407,176 EMS encounters, we identified 13,249 hospitalizations for severe sepsis, of whom 2,596 died in the hospital (19.6%). The crude incidence rate of severe sepsis was 3.3 per 100 EMS encounters, greater than for acute myocardial infarction or stroke (2.3 per 100 and 2.2 per 100 EMS encounters, respectively). More than 40% of all severe sepsis hospitalizations arrived at the emergency department after EMS transport, and 80% of cases were diagnosed on admission. Pre-hospital care intervals, on average, exceeded 45 minutes for those hospitalized with severe sepsis. One-half or fewer of patients with severe sepsis were transported by paramedics (n ¼ 7,114; 54%) or received pre-hospital intravenous access (n ¼ 4,842; 37%). Conclusions: EMS personnel care for a substantial and increasing number of patients with severe sepsis, and spend considerable time on scene and during transport. Given the emphasis on rapid diagnosis and intervention for sepsis, the pre-hospital interval may represent an important opportunity for recognition and care of sepsis.Keywords: sepsis; emergency medical services; epidemiology Severe sepsis represents a large and increasing burden on the U.S. health care system. The incidence of severe sepsis is greater than 3.0 per 1,000 population, and case fatalities approach 20%, accounting for more than $17 billion annually in medical costs (1-3). Even sepsis survivors often suffer with cognitive impairment and functional disability (4, 5). Advances in severe sepsis therapy, such as time-sensitive antibiotic administration and fluid resuscitation, require prompt diagnosis, and in some cases, transfer to referral centers for definitive therapy (6-11). Until now, such early recognition occurs after patients arrive at hospitals, when a critical window for treatment and referral may already have passed.An alternative approach may be to diagnose and treat severe sepsis in the pre-hospital period, using emergency medical services (EMS) personnel (12, 13). More than 800,000 EMS personnel provide care to tens of millions of persons as part of an emergency system (14) that transports more than 35 patients every minute of every day (15). EMS systems already play a key role in the management of acute cardiovascular disease, stroke, and trauma, conditions that benefit from care at optimal centers with advanced ...

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“…Despite spending almost 1 hour with the sickest patients, EMS personnel may be unaware they are transporting a patient with severe sepsis, a major barrier to testing patient or system interventions in pre-hospital sepsis (19). We observed that many EMS encounters hospitalized with severe sepsis were transported by basic life support providers, classified as "nonurgent," and did not receive pre-hospital intravenous access-even though the vast majority were diagnosed on hospital admission.…”

Section: Discussionmentioning

confidence: 91%

“…The changing burden, high case fatality rates, and frequent involvement of EMS in severe sepsis suggest it may deserve consideration along with acute cardiovascular disease and trauma in critical care system-level planning. For practicing EMS personnel, the ample pre-hospital care interval and large sepsis case volume highlight an understudied opportunity to optimize care (19). Few data or consensus exists to guide pre-hospital treatment or advanced notification of severe sepsis to hospitals (13,35,36), and the National EMS Research Agenda does not yet include topics related to infection or severe sepsis (37,38).…”

Section: Discussionmentioning

confidence: 99%

Severe Sepsis in Pre-Hospital Emergency Care

Seymour

¹

,

Rea

²

,

Kahn

³

et al. 2012

Am J Respir Crit Care Med

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Rationale: Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care systempre-hospital emergency care-is unknown. Objectives: We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke. Methods: Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital. Measurements and Main Results: Overall incidence rate of hospitalization with severe sepsis among EMS encounters, as well as pre-hospital characteristics, admission diagnosis, and outcomes. Among 407,176 EMS encounters, we identified 13,249 hospitalizations for severe sepsis, of whom 2,596 died in the hospital (19.6%). The crude incidence rate of severe sepsis was 3.3 per 100 EMS encounters, greater than for acute myocardial infarction or stroke (2.3 per 100 and 2.2 per 100 EMS encounters, respectively). More than 40% of all severe sepsis hospitalizations arrived at the emergency department after EMS transport, and 80% of cases were diagnosed on admission. Pre-hospital care intervals, on average, exceeded 45 minutes for those hospitalized with severe sepsis. One-half or fewer of patients with severe sepsis were transported by paramedics (n ¼ 7,114; 54%) or received pre-hospital intravenous access (n ¼ 4,842; 37%). Conclusions: EMS personnel care for a substantial and increasing number of patients with severe sepsis, and spend considerable time on scene and during transport. Given the emphasis on rapid diagnosis and intervention for sepsis, the pre-hospital interval may represent an important opportunity for recognition and care of sepsis.Keywords: sepsis; emergency medical services; epidemiology Severe sepsis represents a large and increasing burden on the U.S. health care system. The incidence of severe sepsis is greater than 3.0 per 1,000 population, and case fatalities approach 20%, accounting for more than $17 billion annually in medical costs (1-3). Even sepsis survivors often suffer with cognitive impairment and functional disability (4, 5). Advances in severe sepsis therapy, such as time-sensitive antibiotic administration and fluid resuscitation, require prompt diagnosis, and in some cases, transfer to referral centers for definitive therapy (6-11). Until now, such early recognition occurs after patients arrive at hospitals, when a critical window for treatment and referral may already have passed.An alternative approach may be to diagnose and treat severe sepsis in the pre-hospital period, using emergency medical services (EMS) personnel (12, 13). More than 800,000 EMS personnel provide care to tens of millions of persons as part of an emergency system (14) that transports more than 35 patients every minute of every day (15). EMS systems already play a key role in the management of acute cardiovascular disease, stroke, and trauma, conditions that benefit from care at optimal centers with advanced ...

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Prediction of Serious Infection During Prehospital Emergency Care

Cited by 37 publications

References 22 publications

Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands

Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands

Severe Sepsis In Prehospital Emergency Care: Analysis Of Incidence, Care, And Outcome

Severe Sepsis in Pre-Hospital Emergency Care

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