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The Prehospital Sepsis Project: Out-of-Hospital Physiologic Predictors of Sepsis Outcomes

Published online by Cambridge University Press:  12 November 2013

Amado Alejandro Baez ,
Priscilla Hanudel  and
Susan Renee Wilcox
Amado Alejandro Baez
Affiliation:
Los Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina (CEDIMAT), Emergency Medicine/Critical Care, Santo Domingo, Dominican Republic and University of Miami, Division of Emergency Medicine, Miami, Florida USA
Priscilla Hanudel
Affiliation:
University of California, Los Angeles (UCLA), Emergency Medicine, Los Angeles, California USA
Susan Renee Wilcox*
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Emergency Medicine, Boston, Massachusetts USA
*
Correspondence: Susan Renee Wilcox, MD Massachusetts General Hospital Department of Emergency Medicine Department of Anesthesia, Critical Care and Pain Medicine Zero Emerson Place, #3b Boston, MA 02114 USA E-mail [email protected]
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Abstract

Introduction

Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis.

Methods

This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the .05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI).

Results

Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P = .003) and OR 4.81 (CI, 1.16-21.01; P = .0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P = .39; HR >90: P = .60; RR >20 P = .11; SI >0.7 P = .35).

Conclusions

This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

BaezAA, HanudelP, WilcoxSR. The Prehospital Sepsis Project: Out-of-Hospital Physiologic Predictors of Sepsis Outcomes. Prehosp Disaster Med. 2013;28(6):1-4.

Keywords

predictorsprehospitalsepsis
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 6 , December 2013 , pp. 632 - 635
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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