Alam Nadia, Doerga Kirtiedevi Bns, Hussain Tahira, Hussain Sadia, Holleman Frits, Kramer Mark Hh, Nanayakkara Prabath Wb
Departments of Internal Medicine and Section Acute Medicineb, VU University Medical Center, Amsterdam, The Netherlands.
Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Acute Med. 2016;15(4):168-175.
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.
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.
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.
全科医生（GPs）和紧急医疗服务（EMS）人员作为进入急性护理链的切入点发挥着关键作用。本研究旨在调查全科医生和紧急医疗服务人员对脓毒症的识别情况，并评估院前环境中脓毒症识别与患者预后之间的关联。方法设计：在两家学术医院急诊科进行的为期12周的前瞻性观察研究。
在急诊科就诊的年龄大于18岁的脓毒症患者。利用急诊科出院小结和病历中的信息对脓毒症、严重脓毒症和脓毒性休克做出明确诊断。结局指标：主要指标：脓毒症的识别/记录。次要指标：急诊科到达至抗生素使用时间、住院死亡率、住院时间（LOS）和重症监护病房（ICU）入院情况。
本研究共纳入301例患者。全科医生和紧急医疗服务人员分别正确识别并记录了所有脓毒症患者（n = 140）中的31.6%（n = 114）和41.4%。脓毒症的识别和记录随着严重程度的增加而改善。与未记录脓毒症的患者组相比，记录了脓毒症的患者组抗生素使用的平均时间（TTA）几乎减半（全科医生：66.4分钟，紧急医疗服务人员：65.6分钟），未记录脓毒症的患者组为（全科医生：123.9分钟，紧急医疗服务人员：101.5分钟；p值分别为0.365和0.024）。结论：院前环境中工作人员对脓毒症、严重脓毒症和脓毒性休克的识别仍有改进空间。入院前记录脓毒症可减少抗生素使用的时间延迟。
