Objective-To derive and validate a predictive model and novel Emergency Medical Services (EMS) screening tool for severe sepsis (SS).
Design-Retrospective cohort study.Setting-A single EMS system and an urban, public hospital.Patients-Sequential adult, non-trauma, non-arrest, at-risk, EMS-transported patients between January 1, 2011 and December 31, 2012. At-risk patients were defined as having all 3 of the following criteria present in the EMS setting: heart rate >90bpm, 2) respiratory rate >20bpm, and 3) systolic blood pressure <110mmHg.
Interventions-None.Measurements and Main Results-Among 66,439 EMS encounters, 555 met criteria for analysis. Fourteen percent (n=75) of patients had SS, of which 19% (n=14) were identified by EMS clinical judgment. In-hospital mortality for patients with SS was 31% (n=23). Six EMS characteristics were found to be predictors of SS: older age, transport from nursing home, Emergency Medical Dispatch (EMD) 9-1-1 chief complaint category of "Sick Person", hot tactile temperature assessment, low systolic blood pressure, and low oxygen saturation. The final predictive model showed good discrimination in derivation and validation subgroups (AUC 0.843 and 0.820, respectively). Sensitivity of the final model was 91% in the derivation group and 78% in the validation group. At a pre-defined threshold of 2 or more points, prehospital severe sepsis (PRESS) score sensitivity was 86%.Corresponding Author: Carmen C Polito, MD, MS, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205M, Atlanta, GA 30322, Phone: (404) 712-2970, Fax: (404) 712-2974, cpolito@emory.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-The PRESS score is a novel EMS screening tool for SS that demonstrates a sensitivity of 86% and specificity of 47%. Additional validation is needed before this tool can be recommended for widespread clinical use.
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