Severe Sepsis in Pre-Hospital Emergency Care

TLDR

Severe sepsis is highly morbid and common, yet its epidemiology in the pre‑hospital setting is largely unknown; many patients are transported by EMS with limited pre‑hospital IV access and spend substantial time on scene, highlighting the pre‑hospital interval as a critical opportunity for early recognition and intervention. This study aimed to characterize the epidemiology of pre‑hospital severe sepsis in EMS encounters and compare it to acute myocardial infarction and stroke. Using a retrospective, community‑based cohort of all non‑arrest, non‑trauma King County EMS encounters from 2000 to 2009, the authors calculated hospitalization incidence, examined pre‑hospital characteristics, admission diagnoses, and outcomes. Among 407,176 EMS encounters, 13,249 severe sepsis hospitalizations were identified, with a 3.3 per 100 encounter incidence—higher than AMI (2.3) and stroke (2.2)—and a 19.6% in‑hospital mortality; over 40% arrived at.

Abstract

Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care system-pre-hospital emergency care-is unknown.We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke.Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital.Overall incidence rate of hospitalization with severe sepsis among EMS encounters, as well as pre-hospital characteristics, admission diagnosis, and outcomes. Among 407,176 EMS encounters, we identified 13,249 hospitalizations for severe sepsis, of whom 2,596 died in the hospital (19.6%). The crude incidence rate of severe sepsis was 3.3 per 100 EMS encounters, greater than for acute myocardial infarction or stroke (2.3 per 100 and 2.2 per 100 EMS encounters, respectively). More than 40% of all severe sepsis hospitalizations arrived at the emergency department after EMS transport, and 80% of cases were diagnosed on admission. Pre-hospital care intervals, on average, exceeded 45 minutes for those hospitalized with severe sepsis. One-half or fewer of patients with severe sepsis were transported by paramedics (n = 7,114; 54%) or received pre-hospital intravenous access (n = 4,842; 37%).EMS personnel care for a substantial and increasing number of patients with severe sepsis, and spend considerable time on scene and during transport. Given the emphasis on rapid diagnosis and intervention for sepsis, the pre-hospital interval may represent an important opportunity for recognition and care of sepsis.