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Abstract
Objective: To identify studies describing the accuracy of prehospital sepsis identification, and to summarize results of studies of prehospital management for patients with severe sepsis or septic shock
Methods: We conducted a systematic review of 4 research databases to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors abstracted data describing study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis, and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS practitioner diagnosis of sepsis.
Results: Our search identified no randomized controlled trials and 15 cohort studies. Nine studies described the identification of sepsis and 6 described prehospital management or treatment of sepsis. The most common approach to the identification of sepsis involved applying Systemic Inflammatory Response Syndrome (SIRS) criteria or individual vital signs, which had sensitivity ranging from 0.48 to 0.87 when used alone or combined with practitioner impression. Only 4 studies collected information required to calculate specificity (0.47-0.88). A combined sensitivity of 0.61 and specificity of 0.86 for EMS application of vital sign criteria was calculated, while EMS provider recognition alone had a sensitivity of 0.16. Included studies described different aspects of management; 2 studies addressed intravenous fluid resuscitation for treatment.
Conclusions: The available evidence suggests that EMS practitioners can identify sepsis patients with modest sensitivity using vital sign criteria, but few studies have evaluated specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management are needed.
Objective: To identify studies describing the accuracy of prehospital sepsis identification, and to summarize results of studies of prehospital management for patients with severe sepsis or septic shock
Methods: We conducted a systematic review of 4 research databases to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors abstracted data describing study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis, and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS practitioner diagnosis of sepsis.
Results: Our search identified no randomized controlled trials and 15 cohort studies. Nine studies described the identification of sepsis and 6 described prehospital management or treatment of sepsis. The most common approach to the identification of sepsis involved applying Systemic Inflammatory Response Syndrome (SIRS) criteria or individual vital signs, which had sensitivity ranging from 0.48 to 0.87 when used alone or combined with practitioner impression. Only 4 studies collected information required to calculate specificity (0.47-0.88). A combined sensitivity of 0.61 and specificity of 0.86 for EMS application of vital sign criteria was calculated, while EMS provider recognition alone had a sensitivity of 0.16. Included studies described different aspects of management; 2 studies addressed intravenous fluid resuscitation for treatment.
Conclusions: The available evidence suggests that EMS practitioners can identify sepsis patients with modest sensitivity using vital sign criteria, but few studies have evaluated specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management are needed.
Prehospital management and identification of Sepsis by Emergency Medical Services: A Systematic Review
Daniel Lane
Abstract
Objective: To identify studies describing the accuracy of prehospital sepsis identification, and to summarize results of studies of prehospital management for patients with severe sepsis or septic shock
Methods: We conducted a systematic review of 4 research databases to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors abstracted data describing study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis, and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS practitioner diagnosis of sepsis.
Results: Our search identified no randomized controlled trials and 15 cohort studies. Nine studies described the identification of sepsis and 6 described prehospital management or treatment of sepsis. The most common approach to the identification of sepsis involved applying Systemic Inflammatory Response Syndrome (SIRS) criteria or individual vital signs, which had sensitivity ranging from 0.48 to 0.87 when used alone or combined with practitioner impression. Only 4 studies collected information required to calculate specificity (0.47-0.88). A combined sensitivity of 0.61 and specificity of 0.86 for EMS application of vital sign criteria was calculated, while EMS provider recognition alone had a sensitivity of 0.16. Included studies described different aspects of management; 2 studies addressed intravenous fluid resuscitation for treatment.
Conclusions: The available evidence suggests that EMS practitioners can identify sepsis patients with modest sensitivity using vital sign criteria, but few studies have evaluated specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management are needed.
Objective: To identify studies describing the accuracy of prehospital sepsis identification, and to summarize results of studies of prehospital management for patients with severe sepsis or septic shock
Methods: We conducted a systematic review of 4 research databases to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors abstracted data describing study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis, and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS practitioner diagnosis of sepsis.
Results: Our search identified no randomized controlled trials and 15 cohort studies. Nine studies described the identification of sepsis and 6 described prehospital management or treatment of sepsis. The most common approach to the identification of sepsis involved applying Systemic Inflammatory Response Syndrome (SIRS) criteria or individual vital signs, which had sensitivity ranging from 0.48 to 0.87 when used alone or combined with practitioner impression. Only 4 studies collected information required to calculate specificity (0.47-0.88). A combined sensitivity of 0.61 and specificity of 0.86 for EMS application of vital sign criteria was calculated, while EMS provider recognition alone had a sensitivity of 0.16. Included studies described different aspects of management; 2 studies addressed intravenous fluid resuscitation for treatment.
Conclusions: The available evidence suggests that EMS practitioners can identify sepsis patients with modest sensitivity using vital sign criteria, but few studies have evaluated specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management are needed.
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