title: Prehospital management and identification of sepsis by emergency medical services: a systematic review.
abstract: OBJECTIVE
  To identify studies describing the accuracy of prehospital sepsis identification and to summarise results of studies of prehospital management of patients with sepsis, severe sepsis or septic shock.
  
  
  METHODS
  We conducted a systematic review to retrieve studies that evaluated the prehospital identification or treatment of patients with sepsis by emergency medical services (EMS). Two authors extracted data describing the study characteristics, incidence of sepsis among EMS-transported patients, criteria used to identify sepsis and specific treatments provided to patients with sepsis. When possible, we calculated the sensitivity and specificity of EMS provider diagnosis of sepsis.
  
  
  RESULTS
  Our search identified no randomised controlled trials and 16 cohort studies. Eight studies described the identification of sepsis, seven described prehospital management or treatment of sepsis and one described both. The most common approach to the identification of sepsis involved applying systemic inflammatory response syndrome criteria or a combination of vital signs, which had sensitivity ranging from 0.43 to 0.86 when used alone or combined with provider impression. Only four studies collected information required to calculate specificity (0.47-0.87). Meta-analysis was not performed owing to significant heterogeneity and an overall low quality of evidence. A few studies described prehospital sepsis treatment-most commonly intravenous fluid resuscitation.
  
  
  CONCLUSIONS
  The evidence suggests that identification of sepsis in the prehospital setting by EMS providers is carried out with varied success, depending on the strategy used; however, high-quality studies are lacking. Relying on provider impression alone had poor sensitivity, but some moderate-quality evidence supporting structured screening for sepsis with vital signs criteria demonstrated modest sensitivity and specificity. Additional research to improve diagnostic accuracy and explore improvements in EMS management is needed.
authors: Alberta Health Services, Emergency Medical Services, Calgary Zone EMS Headquarters, Calgary, Alberta, Canada Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Ontario, Canada Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada.
authors: Daniel
authors: http://orcid.org/0000-0001-8600-8895
authors: D
authors: Lane
authors: University of Ontario Institute of Technology, Ontario, Canada.
authors: Robbie I
authors: RI
authors: Ichelson
authors: Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital, Ontario, Canada Faculty of Medicine, Institute of Medical Science, University of Toronto, Ontario, Canada.
authors: Ian R
authors: IR
authors: Drennan
authors: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Ontario, Canada Interdepartmental Division of Critical Care, University of Toronto, Ontario, Canada.
authors: Damon C
authors: DC
authors: Scales
mesh_terms: D004632:Emergency Medical Services; D006801:Humans; D018805:Sepsis / Q000175:diagnosis* / Q000628:therapy*
keywords: diagnosis; emergency ambulance systems; infection; paramedics