Early recognition of sepsis through emergency medical services pre-hospital screening

The Surviving Sepsis Campaign implemented a 3-hour bundle including blood cultures, lactate, intravenous fluids, and antibiotics to improve mortality in sepsis. Though difficult to achieve, bundle compliance is associated with decreased hospital mortality. We predict that the implementation of an Em...

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Bibliographic Details
Published in:The American journal of emergency medicine 2019-08, Vol.37 (8), p.1428-1432
Main Authors: Borrelli, George, Koch, Erica, Sterk, Ethan, Lovett, Shannon, Rech, Megan A.
Format: Article
Language:English
Subjects:
Aged
Anti-Bacterial Agents - therapeutic use
Antibiotics
Blood Culture
Bundling
Cardiovascular disease
Clinical outcomes
Demographics
Demography
Emergency medical care
Emergency medical services
Emergency Medical Services - organization & administration
Emergency Service, Hospital - statistics & numerical data
Emergency services
Female
Fluid Therapy - methods
Fluids
Health services
Heart attacks
Hospital Mortality
Humans
Infections
Intravenous administration
Lactic acid
Lactic Acid - blood
Logistic Models
Male
Mass Screening - statistics & numerical data
Middle Aged
Mortality
Multivariate Analysis
Organ Dysfunction Scores
Patient Care Bundles
Patients
Pre-hospital
Quality Improvement
Retrospective Studies
Sepsis
Sepsis - diagnosis
Sepsis - mortality
Sepsis - therapy
Stroke
Time-to-Treatment
United States
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Summary:The Surviving Sepsis Campaign implemented a 3-hour bundle including blood cultures, lactate, intravenous fluids, and antibiotics to improve mortality in sepsis. Though difficult to achieve, bundle compliance is associated with decreased hospital mortality. We predict that the implementation of an Emergency Medical Services (EMS) sepsis screening tool will improve 3-hour bundle compliance. To determine if pre-hospital sepsis screening improves 3-hour bundle compliance. Prospective implementation of an EMS sepsis screening tool (June 2016–November 2016) was compared to a historical control (August 2015–March 2016). The protocol was facilitated via communication between nurses and EMS personnel. The primary outcome was 3-hour bundle compliance. Secondary outcomes included time to individual bundle components. Of 135 patients screened, 20 were positive and included in the study, and subsequently compared to 43 control patients. Baseline demographics were similar, except median Sequential Organ Failure Assessment (SOFA) score was higher for the pre-EMS tool group (5 [interquartile range (IQR) 2–8] vs. 2 [IQR 1–4], p 
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2018.10.036