title: Ambulance patients with nondocumented sepsis have a high mortality risk: a retrospective study.
abstract: OBJECTIVE
  Sepsis is a serious disease leading to high mortality. Early recognition is important because treatment is most effective when started quickly.The primary aim of this retrospective cohort study was to assess how many sepsis patients are documented as septic by ambulance staff. The secondary aims were to investigate how many sepsis patients are transported by ambulance, to compare them with patients transported otherwise, to investigate which factors influence documentation of sepsis and to assess whether documentation influences mortality.
  
  
  METHODS
  We retrieved all data from ambulance and emergency department charts of patients who visited the internist in the emergency department from March 2011 to July 2012.
  
  
  RESULTS
  In total, 47.4% (n=363) sepsis patients were transported by ambulance. These patients were older (71.5 vs. 55.7 years, P<0.0001), admitted more frequently (97.2 vs. 85.4%, P<0.001), significantly more frequently had severe sepsis (47.4 vs. 25.8%, P<0.0001) or septic shock (12.4 vs. 4.0%, P<0.0001), and died more frequently within 28 days (17.9 vs. 7.2%, P<0.0001) than those who were transported otherwise.In 41.9% of ambulance patients, sepsis was not documented by ambulance staff. Measurement of temperature was important for documentation of sepsis (odds ratio 11.2, 95% confidence interval 5.2-24.4). In 32.1% of ambulance patients, sepsis could have been identified by assessing vital signs. Mortality in these nondocumented patients was higher than that in documented patients (25.7 vs. 12.9%, P=0.003).
  
  
  CONCLUSIONS
  Ambulance patients are seriously ill, but sepsis is often not documented by ambulance staff. Nondocumentation is associated with high mortality and could be resolved by assessing vital signs, particularly the temperature.
authors.affiliation: aDepartment of Internal Medicine, Section of Acute Medicine bDepartment of Internal Medicine, Section of Geriatric Medicine cDepartment of Anaesthesiology dSchool of CAPHRI, Maastricht University Medical Centre+, Maastricht University eRegionale Ambulance Voorziening Zuid-Limburg, Maastricht, The Netherlands.
authors.forename: Asselina A
authors.initials: AA
authors.lastname: Roest
authors.forename: Judith
authors.initials: J
authors.lastname: Stoffers
authors.forename: Evelien
authors.initials: E
authors.lastname: Pijpers
authors.forename: Jochen
authors.initials: J
authors.lastname: Jansen
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Stassen
mesh_terms: D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D004282:Documentation / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome