Screening tools for sepsis identification in paramedicine and other emergency contexts: a rapid systematic review

Abstract

Background Sepsis is a life-threatening condition that contributes significantly to protracted hospitalisations globally. The unique positioning of paramedics and other emergency care cadres in emergency contexts enable the prospect of early identification and management of sepsis, however, a standardised screening tool still does not exist in the emergency setting. The objective of this review was to identify and recommend the most clinically ideal sepsis screening tool for emergency contexts such as emergency departments and out-of-hospital emergency contexts. Methods A rapid review of five databases (Medline, Embase, the Cochrane Library, CINAHL, and ProQuest Central) was undertaken, with searches performed on February 10, 2022. Covidence software was used by two authors for initial screening, and full text review was undertaken independently by each reviewer, with conflicts resolved by consensus-finding and a mediator. Systematic reviews, meta-analyses, randomised controlled trials, and prospective observational studies were eligible for inclusion. Data extraction used an a priori template and focused on sensitivity and specificity, with ROBINS-I and ROBIS bias assessment tools employed to assess risk of bias in included studies. Study details and key findings were summarised in tables. The a priori review protocol was registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/3XQ5T). Results The literature search identified 362 results. After review, 18 studies met the inclusion criteria and were included for analysis. There were five systematic reviews, with three including meta-analysis, eleven prospective observational studies, one randomised controlled trial, and one validation study. Conclusions The review recognised that a paucity of evidence exists surrounding standardised sepsis screening tools in the emergency context. The use of a sepsis screening tool in the emergency environment may be prudent, however there is currently insufficient evidence to recommend a single screening tool for this context. A combination of the qSOFA and SIRS may be employed to avoid ‘practice paralysis’ in the interim. The authors acknowledge the inherent potential for publication and selection bias within the review due to the inclusion criteria.

Recognition and Awareness of Sepsis by First-Aid Providers in Adults With Suspected Infection: A Scoping Review

“…We identified three systematic reviews [17][18][19], one scoping review [20], and 11 observational studies [21][22][23][24][25][26][27][28][29][30][31] for inclusion, all of which were conducted in HICs; none were performed in the first-aid setting. No published studies directly addressed a first-aid provider's recognition of sepsis through the presence of specific signs or symptoms in a seriously ill person with the subsequent need to seek further medical attention.…”

“…Studies evaluating physiologic variables that a lay provider could obtain in a first-aid setting, such as temperature, heart rate, and respiratory rate, either in isolation or when assessing using clinical scoring tools, were selected for inclusion. Seven studies assessed screening score performance in the prehospital or in-hospital setting to identify sepsis [17][18][19][22][23][24][25]. One study explored the clinical signs and field assessments by emergency medical service providers of patients with and without a suspicion of sepsis [29].…”

“…One systematic review [ 17 ] and four observational studies [ 24 , 28 , 30 , 31 ] evaluated the prognostic ability of sepsis screening tests performed in the prehospital or emergency setting to predict adverse in-hospital outcomes, such as progression to septic shock, mortality, critical care intervention, or ICU requirement. The qSOFA score was universally evaluated in all the studies but with variable results.…”

“…Three systematic reviews[17][18][19] and four observational studies[22][23][24][25] evaluated the performance of sepsis screening scores to identify adult patients with sepsis in both the prehospital and in-hospital settings and found the accuracy of sepsis recognition by EMS providers to be variable. De Silva et al identified 18 studies that compared the sensitivity and specificity of qSOFA to 31 other screening tools for the diagnosis of sepsis and determined that qSOFA produced high specificity and low sensitivity for the emergency diagnosis of sepsis among people with suspected or confirmed sepsis in either the prehospital setting or Emergency Department (ED)[17]. Lane et al described in a narrative review of 17 articles that the accuracy of prehospital sepsis identification of septic patients by EMS using SIRS criteria or a combination of vital signs was heterogeneous[18].…”

Lobetyolin protects mice against LPS-induced sepsis by downregulating the production of inflammatory cytokines in macrophage

“…The management typically involves administration of appropriate antibiotics along with comprehensive supportive care within a hospital setting (Adegbite et al, 2023). Early recognition and prompt initiation of treatment are crucial for achieving favorable outcomes in septic patients (De Silva et al, 2023). However, despite efforts to improve morbidity and mortality rates associated with sepsis, it remains the leading cause of death among critically ill patients in clinical practice (Borouchaki et al, 2022;Minogue et al, 2023).…”