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Identification of adults with sepsis in the prehospital environment : a systematic review
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Smyth, Michael A., Brace-McDonnell, Samantha J. and Perkins, Gavin D. (2016) Identification of adults with sepsis in the prehospital environment : a systematic review. BMJ Open, 6 (8). e011218. doi:10.1136/bmjopen-2016-011218
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Official URL: http://dx.doi.org/10.1136/bmjopen-2016-011218
Abstract
Objective: 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.
Design: 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.
Setting: Prehospital/emergency medical services (EMS).
Study selection: All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS.
Outcome measures: Recognition of sepsis by EMS clinicians.
Results: 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.
Conclusions: 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.
| Item Type: | Journal Article | ||||||||||
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| Subjects: | R Medicine > RC Internal medicine | ||||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Septicemia -- Treatment, Emergency medical services, Allied health personnel, Systematic reviews (Medical research) | ||||||||||
| Journal or Publication Title: | BMJ Open | ||||||||||
| Publisher: | BMJ | ||||||||||
| ISSN: | 2044-6055 | ||||||||||
| Official Date: | 1 August 2016 | ||||||||||
| Dates: |
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| Volume: | 6 | ||||||||||
| Number: | 8 | ||||||||||
| Page Range: | e011218 | ||||||||||
| DOI: | 10.1136/bmjopen-2016-011218 | ||||||||||
| Status: | Peer Reviewed | ||||||||||
| Publication Status: | Published | ||||||||||
| Access rights to Published version: | Open Access | ||||||||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR) | ||||||||||
| Grant number: | CDRF-2012-05-058 |
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