Identification of adults with sepsis in the prehospital environment: a systematic review
Tóm tắt
Early 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.
Systematic 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.
Prehospital/emergency medical services (EMS).
All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS.
Recognition of sepsis by EMS clinicians.
Owing 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.
Recognition 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.
Từ khóa
Tài liệu tham khảo
Ibrahim, 2013, Can the characteristics of emergency department attendances predict poor hospital outcomes in patients with sepsis?, Singapore Med J, 54, 634, 10.11622/smedj.2013224
Roest AA , Stoffers J , Pijpers E , et al . Ambulance patients with nondocumented sepsis have a high mortality risk: a retrospective study. Eur J Emerg Med 2015. doi:10.1097/MEJ.0000000000000302 doi:10.1097/MEJ.0000000000000302
van der Wekken, 2016, Epidemiology of sepsis and its recognition by emergency medical services personnel in the Netherlands, Prehosp Emerg Care, 20, 90, 10.3109/10903127.2015.1037476
Femling, 2012, EMS sepsis patients are different from walk-in sepsis patients, Ann Emerg Med, 60, S120, 10.1016/j.annemergmed.2012.06.316
McClelland, 2015, A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service, J Paramedic Pract, 7, 459, 10.12968/jpar.2015.7.9.459
American College of Emergency Physicians, 2012, Trauma care systems development, evaluation, and funding. Policy statement, Ann Emerg Med, 60, 249, 10.1016/j.annemergmed.2012.04.027
Erwin, 2011, Can paramedics accurately diagnose sepsis and severe sepsis in the field?, Acad Emerg Med, 1, S23
Polito, 2014, Detection of severe sepsis in the pre-hospital setting: how are we doing?, Crit Care Med, 1, A1603, 10.1097/01.ccm.0000458506.83088.d1
Boardman, 2009, Prehospital management of a patient with severe sepsis, J Paramedic Pract, 1, 183, 10.12968/jpar.2009.1.5.42060
Schünemann H , Brożek J , Guyatt G , et al . GRADE handbook. Secondary GRADE handbook, 2013. http://www.guidelinedevelopment.org/handbook/
Shiuh, 2012, An emergency medical services sepsis protocol with point-of-care lactate accurately identifies out-of-hospital patients with severe infection and sepsis, Ann Emerg Med, 1, S44, 10.1016/j.annemergmed.2012.06.097
Travers, 2013, Can paramedics diagnose sepsis in the prehospital setting? A feasibility study, Can J Emerg Med, 15, S55
Seymour CW , Kahn JM , Cooke CR , et al . Out-of-hospital prediction of critical illness in a population-based cohort. Am J Respir Crit Care Med 2010;181 (Meeting Abstracts).
Seymour, 2012, Understanding of sepsis among emergency medical services: a survey study, J Emerg Med, 42, 666, 10.1016/j.jemermed.2011.06.013
Báez, 2013, Prehospital Sepsis Project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers, Prehosp Disaster Med, 28, 104, 10.1017/S1049023X12001744
Shime, 2015, A survey of the competency of ambulance service personnel in the diagnosis and management of sepsis, J Emerg Med, 49, 147, 10.1016/j.jemermed.2014.12.066