Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

Moore, Chris; Bulger, Jenna; Morgan, Matt; Driscoll, Timothy; Porter, Alison; Islam, Saiful; Smyth, Michael A.; Perkins, Gavin D.; Sewell, Bernadette; Rainer, Timothy; Nanayakkara, Prabath W.B.; Okolie, Chukwudi; Allen, Susan; Fegan, Greg; Davies, Jane; Francis, Nick; Smith, Fang Gao; Ellis, Gemma; Shanahan, Tracy; Howe, Robin; Snooks, Helen

doi:10.1186/s40814-018-0258-8

Cited by 8 publications

(16 citation statements)

References 19 publications

(16 reference statements)

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“…These reductions in TTA may be a result of the increased awareness of a critical disease when a tentative diagnosis of sepsis or other infections is mentioned explicitly. With that purpose in mind, an array of screening tools regarding sepsis has been employed 4,5,11,12 …”

Section: Discussionmentioning

confidence: 99%

“…Early treatment of sepsis is associated with better survival rates and outcome 3,8‐14 . With every 1‐hour delay of antibiotic treatment mortality has been reported to increase by 3 to 7 per cent 4‐6 …”

Section: Introductionmentioning

confidence: 99%

“…Different scoring systems have shown considerable variability in pre‐hospital recognition of sepsis. The sensitivity has been reported as ranging from 10% to 87% 4,6,9‐11,16 . This uncertainty might affect patients in critical need of antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

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Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Mikkelsen

Gregers²,

Justesen

et al. 2021

Acta Anaesthesiol Scand

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Background Rapid recognition and antibiotic treatment, preferably preceded by blood cultures (BCs), is a mainstay in sepsis therapy. The objective of this investigation was to determine if pre‐hospital BCs were feasible and drawn with an acceptably low level of contamination and to investigate whether pre‐hospital antibiotics were administered on correct indications. Methods We performed a register‐based study in a pre‐hospital physician‐manned mobile emergency care unit (MECU) operating in a mixed urban/rural area in Denmark. All patients who received pre‐hospital antibiotics by the MECU from November 2013 to October 2018 were reviewed. Outcome measures were characterisation of microbial findings and subsequent in‐hospital confirmation of the pre‐hospital indication for antibiotics. Results One‐hundred‐and‐nineteen patients received antibiotics pre‐hospitally. Six were excluded. One‐hundred‐and‐thirteen patients were included in the study. BCs were drawn in 107 of the 113 patients (94.7% [88.8%‐98.0%]). We found a true pathogen of sepsis in 29 (27.1% [19.0%‐36.6%]) of these 107 patients. Nine (8.4% [3.9%‐15.4%]) patients had contaminated pre‐hospital BCs. Forty‐nine of all patients (36.3% [27.4%‐45.9%]) had causative pathogens in either their BCs or other samples confirming the pre‐hospital tentative diagnosis. Eighty‐two (72.6% [63.4%‐80.5%]) patients received antibiotic therapy in‐hospitally, while 27 (23.9% [16.4%‐32.8%]) were assigned an in‐hospital diagnosis not associated with infection. Four (3.5% [1.0%‐8.8%]) patients died in hospital before a diagnosis was established. Conclusions Pre‐hospital administration of antibiotics preceded by BCs is feasible, although with somewhat high blood culture contamination rates. Antibiotics are administered on reasonable indications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Mikkelsen

Gregers²,

Justesen

et al. 2021

Acta Anaesthesiol Scand

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“…Around 10 days later, we followed normal research consent processes when patients were visited by a research nurse who discussed the study and provided written materials. Research ethics committees consider that this approach is less stressful and gives more time for potential participants to consider taking part in research 54–56. Gaining consent from patients to participate in prehospital research must recognise the cognitive effect of emergency care 57.…”

Section: Discussionmentioning

confidence: 99%

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

et al. 2019

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ObjectiveTo explore patients’ experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury.DesignQualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture.SettingPatients treated by paramedics in the catchment area of one emergency department in South Wales.ParticipantsSix patients and one carer of a patient who received fascia iliaca compartment block (FICB).InterventionFICB administered to patients with suspected hip fracture by trained paramedics. We randomly allocated eligible patients to FICB—a local anaesthetic injection directly into the hip region—or usual care—most commonly morphine—using audited scratch cards.OutcomesAcceptability and experience of receiving FICB, assessed through interview data. We audio-recorded, with participants’ consent, and conducted thematic analysis of interview transcripts. The analysis team comprised two researchers, one paramedic and one lay member.ResultsPatients had little or no memory of being offered, consenting to or receiving FICB. They recalled the reassuring manner and high quality of care received. They accepted FICB without question. Partial or confused memory characterised experience of subsequent hospital care until surgery. They said their priorities when calling for emergency help were to receive effective care. After hospital treatment, they wanted to regain their health and mobility and resume the quality of life they experienced before their injury.ConclusionsThis study did not raise any concerns about the acceptability of FICB administered at the scene of injury by paramedics to people with suspected hip fracture. It adds to existing evidence about patient and carer experience of on-scene care for people with suspected hip fracture. Further research is needed to assess safety, effectiveness and cost effectiveness of this health technology in a new setting.Trial registration numberNCT60065373.

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“…Since the RAPID study, scratchcards have been used successfully as a method of allocation concealment in another randomised controlled study investigating prehospital recognition and antibiotics for 999 patients with sepsis. 7 …”

Section: Discussionmentioning

confidence: 99%

Use of scratchcards for allocation concealment in a prehospital randomised controlled trial

et al. 2018

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BackgroundRapid Analgesia for Prehospital Hip Disruption was a small study designed to determine the feasibility of undertaking a randomised controlled trial (RCT) to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block as early prehospital pain relief to patients with a fractured hip. The objective was to devise a simple and effective method of random allocation concealment suitable for use by paramedics while in the emergency prehospital setting.MethodsScratchcards were produced using scratch-off silver stickers which concealed the trial arm allocation. Paramedics were each allocated a unique range of consecutive numbers, used as both the scratchcard number and the patient’s study ID. The cards were designed to allow the paramedic to write on the incident number, date and signature. A small envelope holding the cards was prepared for each paramedic. The study took place between 28 June 2016 and 31 July 2017 in the Swansea area.ResultsNineteen trial paramedics used 71 scratchcards throughout the study and reported no problems randomly allocating patients using the scratchcards. Five protocol deviations were reported in relation to scratchcard use. On auditing the scratchcards, all unused cards were located, and no evidence of tampering with the silver panel was found.ConclusionParamedics can use scratchcards as a method of randomly allocating patients in trials in prehospital care. In the future, a method that allows only the top card to be selected and a more protective method of storing the cards should be used. Scratchcards can be considered for wider use in RCTs in the emergency prehospital setting.Trial registration numberISRCTN60065373; Post-results.

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Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

Cited by 8 publications

References 19 publications

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Pre‐hospital antibiotic therapy preceded by blood cultures in a physician‐manned mobile emergency care unit

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

Use of scratchcards for allocation concealment in a prehospital randomised controlled trial

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