title: Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study.
abstract: Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4-83.0), while specificity was 78.8% (95% CI 75.2-82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8-38.1) and 95.9% (95% CI 93.6-97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.
authors.affiliation: Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9; Trauma Nova Scotia, Room 1-026B, Centennial Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9.
authors.forename: Robert S
authors.identifier: 0000-0003-1195-5497
authors.initials: RS
authors.lastname: Green
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7; Emergency Health Service, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, Canada B3B 2B2.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Travers
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7.
authors.forename: Edward
authors.initials: E
authors.lastname: Cain
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Campbell
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7; Emergency Health Service, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, Canada B3B 2B2.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Jensen
authors.affiliation: Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7.
authors.forename: David A
authors.initials: DA
authors.lastname: Petrie
authors.affiliation: Trauma Nova Scotia, Room 1-026B, Centennial Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9.
authors.forename: Mete
authors.initials: M
authors.lastname: Erdogan
authors.affiliation: Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada B3H 4R2.
authors.forename: Gredi
authors.initials: G
authors.lastname: Patrick
authors.affiliation: Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9.
authors.forename: Ward
authors.initials: W
authors.lastname: Patrick