The epidemiology of infections and sepsis in the prehospital setting
CCCF ePoster library. Lane D. Oct 4, 2017; 198199; 113
Daniel Lane
Daniel Lane
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Abstract
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The epidemiology of infections and sepsis in the prehospital setting

Lane Daniel J. M.Sc1,2; Blanchard Ian E. M.Sc, ACP3,4; Oleynick Christopher, B.Sc5; Lazarenko Gerald MD3,4; Morrison Laurie J. MD, M.Sc 1,2,5; Wunsch Hannah MD, M.Sc 1,6,7,8; Cheskes Sheldon MD 2,6,9; Lin Steve MDCM, M.Sc 1,2,5; Saskin Refik M.S 1,6; Scales Damon C. MD, PhD 1,2,6,7,8.

 

1. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto

2. Rescu, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

3. Alberta Health Services, Emergency Medical Services, Alberta, Canada

4. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

5. Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

6. Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

7. Institute of Clinical Evaluative Sciences, University Health Network, Toronto, Ontario, Canada

8. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Ontario, Canada

9. Interdepartmental Division of Critical Care, University of Toronto, Ontario, Canada

10. Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada


Introduction:
Sepsis is a life-threatening syndrome caused by a dysregulated immune response to infection(1). Early recognition and intervention are critical to improve patient outcomes(2). In modern healthcare systems, paramedics often encounter patients with sepsis before other clinicians, offering an important opportunity for even earlier sepsis care(3).

Objective:
We sought to estimate the incidence and examine clinical and operational characteristics of patients with infection or sepsis who are transported by paramedics in a Canadian Emergency Medical Services (EMS) system.

Methods:
A one-year cohort of all EMS transport events in the province of Alberta, Canada was linked to in-hospital administrative databases. Infection and sepsis were identified using administrative Emergency Department (ED) diagnosis codes and EMS clinical information, consistent with recommendations from the Sepsis-3 definition(1). Clinical characteristics (e.g. age, sex, vital signs), operational factors (e.g. prehospital encounter time), and treatments provided by paramedics (e.g. intravenous[IV] fluid treatment) were evaluated in patients with infection or sepsis, and compared to those of other patients transported by paramedics.

Results:
The incidence of infections (10%) and sepsis (2.1%) are notable within the paramedic-transported adult patient population, with more than half (56%) of these patients requiring admission to hospital. Fever (greater than 37.8 C) on presentation to paramedics was somewhat uncommon among patients with infections (17%), however, altered mental status (24.6%) and tachypnea (greater than 22 breaths per minute; 31.6%) were more common. Compared to other patients transported by paramedics, patients with sepsis were generally older (mean 75 vs. 60 years), female (56.4%) and more frequently had altered vital signs, most commonly altered Glasgow Coma Score (less than 15; 61%), tachypnea (48%), low oxygen saturation (less than 90%; 34%), or fever (24.5%). Patients with sepsis were more likely to have a high priority dispatch (38% vs. 31%), but also had longer prehospital intervals (mean 44 min vs. 39 min, p<0.001) despite shorter transport distances (mean 15 km vs. 16 km, p=0.004). IV lines were initiated in 55% of septic patients compared to 34% of non-septic patients. In septic patients with a systolic blood pressure less than 100 mmHg, 70% received an IV but only 26% of those patients received at least 500 mL of fluid before arriving in the ED. The in-hospital mortality rate for paramedic-transported patients with infection or sepsis was 6.6% and 19%, respectively.

Conclusion:

Infections and sepsis are common among paramedic-transported patients, and paramedics spend a considerable time with these patients prior to arriving in the ED. These patients frequently have altered vital signs, suggesting earlier recognition is feasible. The in-hospital mortality of these patients is high, supporting the need to study earlier interventions provided in the prehospital setting. 

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