The prehospital sepsis project: Out-of-hospital physiologic predictors of sepsis outcomes

Amado Alejandro Baez, Priscilla Hanudel, Susan Renee Wilcox

Research output: Contribution to journalArticle

Abstract

Introduction Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. Methods This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the.05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Results Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P =.003) and OR 4.81 (CI, 1.16-21.01; P =.0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P =.39; HR >90: P =.60; RR >20 P =.11; SI >0.7 P =.35). Conclusions This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

Original languageEnglish (US)
JournalPrehospital and Disaster Medicine
Volume28
Issue number6
DOIs
StatePublished - Dec 1 2013

Fingerprint

Sepsis
Respiratory Rate
Shock
Intensive Care Units
Length of Stay
Odds Ratio
Arterial Pressure
Emergency Medical Services
International Classification of Diseases
Mechanical Ventilators
Septic Shock
Hospital Mortality
Cross-Sectional Studies
Heart Rate
Mortality

Keywords

  • Predictors
  • Prehospital
  • Sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

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The prehospital sepsis project : Out-of-hospital physiologic predictors of sepsis outcomes. / Baez, Amado Alejandro; Hanudel, Priscilla; Wilcox, Susan Renee.

In: Prehospital and Disaster Medicine, Vol. 28, No. 6, 01.12.2013.

Research output: Contribution to journalArticle

Baez, Amado Alejandro ; Hanudel, Priscilla ; Wilcox, Susan Renee. / The prehospital sepsis project : Out-of-hospital physiologic predictors of sepsis outcomes. In: Prehospital and Disaster Medicine. 2013 ; Vol. 28, No. 6.
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abstract = "Introduction Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. Methods This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the.05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Results Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9{\%}), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P =.003) and OR 4.81 (CI, 1.16-21.01; P =.0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P =.39; HR >90: P =.60; RR >20 P =.11; SI >0.7 P =.35). Conclusions This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.",
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N2 - Introduction Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. Methods This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the.05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Results Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P =.003) and OR 4.81 (CI, 1.16-21.01; P =.0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P =.39; HR >90: P =.60; RR >20 P =.11; SI >0.7 P =.35). Conclusions This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

AB - Introduction Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis. Methods This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the.05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI). Results Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P =.003) and OR 4.81 (CI, 1.16-21.01; P =.0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P =.39; HR >90: P =.60; RR >20 P =.11; SI >0.7 P =.35). Conclusions This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

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