Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome

Abstract

Background The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. Methods This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. Results In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. Conclusions The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis. Electronic supplementary material The online version of this article (10.1186/s12873-019-0255-0) contains supplementary material, which is available to authorized users.

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

“…The fact that pain was associated with a time-sensitive diagnosis is not unexpected, as this is previously described [ 38 , 48 , 49 ]. Pain may be due to the loss of perfusion (angina, myocardial infarction) and low oxygen tension (hypoxia) with resulting inflammatory response [ 50 ].…”

“…A large proportion had a history of atrial fibrillation [8], which indicated that it was not a new finding that caused adverse illness among these patients. The fact that pain was associated with a time-sensitive diagnosis is not unexpected, as this is previously described [38,48,49]. Pain may be due to the loss of perfusion (angina, myocardial infarction) and low oxygen tension (hypoxia) with resulting inflammatory response [50].…”

Predicting mortality among septic patients presenting to the emergency department–a cross sectional analysis using machine learning

“…Several of these variables are not included in previously suggested predictive tools [ 8 , 9 , 12 ]. Prior studies support that low oxygen saturation, abnormal level of consciousness, the absence of chills, fever and rigors in addition to hyperglycaemia, are predictive of poor outcome for septic patients [ 13 , 14 ]. It may be surprising that the results suggest that fever and chills are protective in sepsis, ie have a lower mortality.…”

“…Another explanation to a better outcome could be that patients with these symptoms are more easily recognised as septic, hence receive timely treatment. Prior studies included either septic patients arriving with EMS or patients with septic shock, [ 13 , 14 ] while the current study includes all septic patients presenting to the ED-setting. Thus, is likely to include septic patients with a greater variation of disease severity.…”

“…Variables reflective of symptom presentation have been shown to be predictive of mortality among septic patients [ 13 , 14 ]. Although the prior study using machine learning methods did include a large number of variables [ 12 ] none of them were reflective of symptoms at presentation.…”