Christopher L Hunter1, Salvatore Silvestri2, George Ralls3, Amanda Stone3, Ayanna Walker3, Linda Papa2. 1. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL; University of Central Florida College of Medicine, Orlando, FL. Electronic address: christopher.hunter@ocfl.net. 2. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL; University of Central Florida College of Medicine, Orlando, FL. 3. Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL.
Abstract
OBJECTIVE: To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2). METHODS: We conducted a prospective cohort study among sepsis alerts activated by emergency medical services during a 12 month period after the initiation of a new sepsis screening protocol utilizing ≥2 SIRS criteria and ETCO2 levels of ≤25 mmHg in patients with suspected infection. The outcomes of those that met all criteria of the protocol were compared to those that did not. The main outcome was the diagnosis of sepsis and severe sepsis. Secondary outcomes included mortality and in-hospital lactate levels. RESULTS: Of 330 sepsis alerts activated, 183 met all protocol criteria and 147 did not. Sepsis alerts that followed the protocol were more frequently diagnosed with sepsis (78% vs 43%, P < .001) and severe sepsis (47% vs 7%, P < .001), and had a higher mortality (11% vs 5%, P = .036). Low ETCO2 levels were the strongest predictor of sepsis (area under the ROC curve (AUC) of 0.99, 95% CI 0.99-1.00; P < .001), severe sepsis (AUC 0.80, 95% CI 0.73-0.86; P < .001), and mortality (AUC 0.70, 95% CI 0.57-0.83; P = .005) among all prehospital variables. Sepsis alerts that followed the protocol had a sensitivity of 90% (95% CI 81-95%), a specificity of 58% (95% CI 52-65%), and a negative predictive value of 93% (95% CI 87-97%) for severe sepsis. There were significant associations between prehospital ETCO2 and serum bicarbonate levels (r = 0.415, P < .001), anion gap (r = -0.322, P < .001), and lactate (r = -0.394, P < .001). CONCLUSION: A prehospital screening protocol utilizing SIRS criteria and ETCO2 predicts sepsis and severe sepsis, which could potentially decrease time to therapeutic intervention.
OBJECTIVE: To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2). METHODS: We conducted a prospective cohort study among sepsis alerts activated by emergency medical services during a 12 month period after the initiation of a new sepsis screening protocol utilizing ≥2 SIRS criteria and ETCO2 levels of ≤25 mmHg in patients with suspected infection. The outcomes of those that met all criteria of the protocol were compared to those that did not. The main outcome was the diagnosis of sepsis and severe sepsis. Secondary outcomes included mortality and in-hospital lactate levels. RESULTS: Of 330 sepsis alerts activated, 183 met all protocol criteria and 147 did not. Sepsis alerts that followed the protocol were more frequently diagnosed with sepsis (78% vs 43%, P < .001) and severe sepsis (47% vs 7%, P < .001), and had a higher mortality (11% vs 5%, P = .036). Low ETCO2 levels were the strongest predictor of sepsis (area under the ROC curve (AUC) of 0.99, 95% CI 0.99-1.00; P < .001), severe sepsis (AUC 0.80, 95% CI 0.73-0.86; P < .001), and mortality (AUC 0.70, 95% CI 0.57-0.83; P = .005) among all prehospital variables. Sepsis alerts that followed the protocol had a sensitivity of 90% (95% CI 81-95%), a specificity of 58% (95% CI 52-65%), and a negative predictive value of 93% (95% CI 87-97%) for severe sepsis. There were significant associations between prehospital ETCO2 and serum bicarbonate levels (r = 0.415, P < .001), anion gap (r = -0.322, P < .001), and lactate (r = -0.394, P < .001). CONCLUSION: A prehospital screening protocol utilizing SIRS criteria and ETCO2 predicts sepsis and severe sepsis, which could potentially decrease time to therapeutic intervention.
Authors: Christopher L Hunter; Salvatore Silvestri; George Ralls; Amanda Stone; Ayanna Walker; Neal Mangalat; Linda Papa Journal: West J Emerg Med Date: 2018-03-13
Authors: Michael A Smyth; Daniel Gallacher; Peter K Kimani; Mark Ragoo; Matthew Ward; Gavin D Perkins Journal: Scand J Trauma Resusc Emerg Med Date: 2019-07-16 Impact factor: 2.953
Authors: Francisco Martín-Rodríguez; Raúl López-Izquierdo; Carlos Del Pozo Vegas; Juan F Delgado-Benito; Carmen Del Pozo Pérez; Virginia Carbajosa Rodríguez; Agustín Mayo Iscar; José Luis Martín-Conty; Carlos Escudero Cuadrillero; Miguel A Castro-Villamor Journal: Emerg Med Int Date: 2019-07-01 Impact factor: 1.112
Authors: Diana Carolina López-Medina; Marcela Henao-Perez; Jaime Arenas-Andrade; Emel David Hinestroza-Marín; Fabián Alberto Jaimes-Barragán; Oscar Iván Quirós-Gómez Journal: Rev Bras Ter Intensiva Date: 2020-05-08
Authors: Mitchell Barneck; Linda Papa; Ashley Cozart; Kain Lentine; Jay Ladde; Linh Nguyen; Jeremy Mayfield; Josef Thundiyil Journal: J Am Coll Emerg Physicians Open Date: 2021-07-17