Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, JTN 266 Birmingham, AL 35249, USA.
Resuscitation. 2010 Feb;81(2):193-7. doi: 10.1016/j.resuscitation.2009.11.008. Epub 2009 Dec 16.
Emergency Medical Services (EMS) systems play key roles in the rapid identification and treatment of critical illness such as trauma, myocardial infarction and stroke. EMS often provides care for sepsis, a life-threatening sequelae of infection. In this study of Emergency Department patients admitted to the hospital with an infection, we characterized the patients receiving initial care by EMS.
We prospectively studied patients with suspected infection presenting to a 50,000 visit urban, academic ED from September 16, 2005-September 30, 2006. We included patients who had abnormal ED vital signs or required hospital admission. We identified patients that received EMS care. Between EMS and non-EMS patients, we compared patient age, sex, nursing home residency, vital signs, comorbidities, source of infection, organ dysfunction, sepsis severity and mortality. We analyzed the data using univariate odds ratios, the Wilcoxon rank-sum test and multivariate logistic regression.
Of 4613 ED patients presenting with serious infections, 1576 (34.2%) received initial EMS care. The mortality rate among those transported by EMS was 126/1576 (8.0%) compared to 67/3037 (2.2%) in those who were not. Adjusted mortality was higher for EMS (OR 1.8, 95% CI: 1.3-2.6). Of patients who qualified for protocolized sepsis care in the ED, 99/162 (61.1%) were transported via EMS. EMS patients were more likely to present with severe sepsis (OR 3.9; 3.4-4.5) or septic shock (OR 3.6; 2.6-5.0). EMS patients had higher sepsis acuity (mortality in ED sepsis score 6 vs. 3, p<0.001).
EMS provides initial care for over one-third of ED infection patients, including the majority of patients with severe sepsis, septic shock, and those who ultimately die. EMS systems may offer important opportunities for advancing sepsis diagnosis and care.
急救医疗服务（EMS）系统在快速识别和治疗创伤、心肌梗死和中风等危急病症方面发挥着关键作用。EMS 经常为脓毒症提供治疗，脓毒症是感染的一种危及生命的后遗症。在这项对因感染而住院的急诊科患者的研究中，我们对接受 EMS 初始治疗的患者进行了特征描述。
我们前瞻性研究了 2005 年 9 月 16 日至 2006 年 9 月 30 日期间在一家拥有 50000 次就诊量的城市学术急诊科就诊的疑似感染患者。我们纳入了 ED 生命体征异常或需要住院的患者。我们确定了接受 EMS 护理的患者。在 EMS 患者和非 EMS 患者之间，我们比较了患者年龄、性别、疗养院居住情况、生命体征、合并症、感染源、器官功能障碍、脓毒症严重程度和死亡率。我们使用单变量比值比、Wilcoxon 秩和检验和多变量逻辑回归分析数据。
在 4613 名 ED 患有严重感染的患者中，有 1576 名（34.2%）接受了初始 EMS 护理。通过 EMS 转运的患者死亡率为 126/1576（8.0%），而未通过 EMS 转运的患者死亡率为 67/3037（2.2%）。调整后的死亡率在 EMS 组更高（OR 1.8，95%CI：1.3-2.6）。在符合 ED 协议化脓毒症治疗标准的患者中，有 99/162 名（61.1%）通过 EMS 转运。EMS 患者更有可能出现严重脓毒症（OR 3.9；3.4-4.5）或感染性休克（OR 3.6；2.6-5.0）。EMS 患者的脓毒症严重程度更高（ED 脓毒症评分 6 分的死亡率与 3 分的死亡率相比，p<0.001）。
EMS 为超过三分之一的 ED 感染患者提供了初始治疗，包括大多数严重脓毒症、感染性休克患者以及最终死亡的患者。EMS 系统可能为推进脓毒症诊断和治疗提供了重要机会。
