Identification of adults with sepsis in the prehospital environment: a systematic review

BMJ Open - Tập 6 Số 8 - Trang e011218 - 2016
Michael A. Smyth1,2,3, Samantha Brace-McDonnell1,4, Gavin D. Perkins1,4
1Clinical Trials Unit, University of Warwick, Coventry, UK
2Midlands Air Ambulance, Stourbridge, UK
3West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
4Heart of England Hospital NHS Foundation Trust, Birmingham, UK

Tóm tắt

ObjectiveEarly identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition.DesignSystematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted.SettingPrehospital/emergency medical services (EMS).Study selectionAll studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS.Outcome measuresRecognition of sepsis by EMS clinicians.ResultsOwing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool.ConclusionsRecognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit.

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BMJ Open

Tập 6 Số 8

e011218

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