title: Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool.
abstract: OBJECTIVE
  To derive and validate a predictive model and novel emergency medical services (EMS) screening tool for severe sepsis (SS).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A single EMS system and an urban, public hospital.
  
  
  METHODS
  Sequential adult, nontrauma, nonarrest, at-risk, EMS-transported patients between January 1, 2011, and December 31, 2012 were included in the study. At-risk patients were defined as having all 3 of the following criteria present in the EMS setting: (1) heart rate greater than 90 beats/min, (2) respiratory rate greater than 20 beats/min, and (3) systolic blood pressure less than 110 mm Hg.
  
  
  METHODS
  None.
  
  
  RESULTS
  Among 66,439 EMS encounters, 555 met the criteria for analysis. Fourteen percent (n = 75) of patients had SS, of which 19% (n = 14) were identified by EMS clinical judgment. In-hospital mortality for patients with SS was 31% (n = 23). Six EMS characteristics were found to be predictors of SS: older age, transport from nursing home, Emergency Medical Dispatch (EMD) 9-1-1 chief concern category of "sick person," hot tactile temperature assessment, low systolic blood pressure, and low oxygen saturation. The final predictive model showed good discrimination in derivation and validation subgroups (areas under curves, 0.843 and 0.820, respectively). Sensitivity of the final model was 91% in the derivation group and 78% in the validation group. At a predefined threshold of 2 or more points, prehospital severe sepsis (PRESS) score sensitivity was 86%.
  
  
  CONCLUSIONS
  The PRESS score is a novel EMS screening tool for SS that demonstrates a sensitivity of 86% and a specificity of 47%. Additional validation is needed before this tool can be recommended for widespread clinical use.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA. Electronic address: cpolito@emory.edu.
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Polito
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, GA.
authors.forename: Alex
authors.initials: A
authors.lastname: Isakov
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, GA.
authors.forename: Arthur H
authors.initials: AH
authors.lastname: Yancey
authors.affiliation: Department of Emergency Medicine, Northwestern University, Chicago, IL.
authors.forename: Duncan K
authors.initials: DK
authors.lastname: Wilson
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Blake A
authors.initials: BA
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine, Emory University, Atlanta, GA.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bloom
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Sevransky
mesh_terms: D000367:Age Factors; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis*; D055986:Vital Signs