title: Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study.
abstract: BACKGROUND
  General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals.
  
  
  METHODS
  Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission.
  
  
  RESULTS
  A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p: 0.365 and p: 0.024 respectively). Conclusions There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.
authors.affiliation: Departments of Internal Medicine and Section Acute Medicineb, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nadia
authors.initials: N
authors.lastname: Alam
authors.affiliation: Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Kirtiedevi Bns
authors.initials: KB
authors.lastname: Doerga
authors.affiliation: Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Tahira
authors.initials: T
authors.lastname: Hussain
authors.affiliation: Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Sadia
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Departments of Internal Medicine and Section Acute Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Frits
authors.initials: F
authors.lastname: Holleman
authors.affiliation: Departments of Internal Medicine and Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark Hh
authors.initials: MH
authors.lastname: Kramer
authors.affiliation: Departments of Internal Medicine and Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Prabath Wb
authors.initials: PW
authors.lastname: Nanayakkara
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003422:Critical Care / Q000458:organization & administration; D004282:Documentation; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D058005:General Practitioners; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D018570:Risk Assessment; D012380:Role; D018805:Sepsis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015996:Survival Rate; D061665:Time-to-Treatment; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents