Out-of-hospital characteristics and care of patients with severe sepsis: a cohort study.
OBJECTIVE
Early recognition and treatment in severe sepsis improve outcomes. However, out-of-hospital patient characteristics and emergency medical services (EMS) care in severe sepsis is understudied. Our goals were to describe out-of-hospital characteristics and EMS care in patients with severe sepsis and to evaluate associations between out-of-hospital characteristics and severity of organ dysfunction in the emergency department (ED).


METHODS
We performed a secondary data analysis of existing data from patients with severe sepsis transported by EMS to an academic medical center. We constructed multivariable linear regression models to determine if out-of-hospital factors are associated with serum lactate and sequential organ failure assessment (SOFA) in the ED.


RESULTS
Two hundred sixteen patients with severe sepsis arrived by EMS. Median serum lactate in the ED was 3.0 mmol/L (interquartile range, 2.0-5.0) and median SOFA score was 4 (interquartile range, 2-6). Sixty-three percent (135) of patients were transported by advanced life support providers and 30% (62) received intravenous fluid. Lower out-of-hospital Glasgow Coma Scale score was independently associated with elevated serum lactate (P < .01). Out-of-hospital hypotension, greater respiratory rate, and lower Glasgow Coma Scale score were associated with greater SOFA (P < .01).


CONCLUSIONS
Out-of-hospital fluid resuscitation occurred in less than one third of patients with severe sepsis, and routinely measured out-of-hospital variables were associated with greater serum lactate and SOFA in the ED.
Seymour
Christopher W
CW
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA 98104, USA. seymoc@u.washington.edu
Band
Roger A
RA
Cooke
Colin R
CR
Mikkelsen
Mark E
ME
Hylton
Julie
J
Rea
Tom D
TD
Goss
Christopher H
CH
Gaieski
David F
DF
D000046:Academic Medical Centers; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010043:Outcome and Process Assessment, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy*; D012772:Shock, Septic
D019344:Lactic Acid
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