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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 ISSN 2044-6055.

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Official URL: http://dx.doi.org/10.1136/bmjopen-2016-011218

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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
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
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:
DateEvent
1 August 2016Published
5 August 2016Available
26 May 2016Accepted
25 January 2016Submitted
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 (Creative Commons)
Date of first compliant deposit: 21 March 2017
Date of first compliant Open Access: 21 March 2017
Funder: National Institute for Health Research (Great Britain) (NIHR)
Grant number: CDRF-2012-05-058

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