Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool

Polito, Carmen; Isakov, Alex; Yancey, Arthur; Wilson, Duncan; Anderson, Blake; Bloom, Ingrid; Martin, Greg S.; Sevransky, Jonathan

doi:10.1016/j.ajem.2015.04.024

Cited by 39 publications

(27 citation statements)

References 24 publications

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“… 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%

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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Section: Resultsmentioning

confidence: 99%

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

2016

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“…There are limited reports of validated screening tools for recognition of sepsis in the prehospital setting. One tool recently developed and validated is the prehospital severe sepsis (PRESS) screening tool which involves a score calculated from EMS data on 6 risk factors [ 15 ]. Using the PRESS tool in the setting of an urban public hospital, prehospital recognition of severe sepsis by EMS staff had a sensitivity of 86% and a specificity of 47% [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…One tool recently developed and validated is the prehospital severe sepsis (PRESS) screening tool which involves a score calculated from EMS data on 6 risk factors [ 15 ]. Using the PRESS tool in the setting of an urban public hospital, prehospital recognition of severe sepsis by EMS staff had a sensitivity of 86% and a specificity of 47% [ 15 ]. The Sepsis Alert Protocol is another screening tool for EMS providers and was found to accurately identify severe sepsis in 47.8% of cases in a pilot study [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

Green

Travers

Cain

et al. 2016

Emergency Medicine International

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Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.

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“…This should not be limited to the ICU but include the emergency department and the wards (and potentially both pre-hospital emergency care and outpatient facilities for sepsis screening as well) [122,123]. These can be intra-location delivery systems (i.e.…”

Section: Administration/epidemiologymentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool

Cited by 39 publications

References 24 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

Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

Surviving sepsis campaign: research priorities for sepsis and septic shock

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