University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
Am J Emerg Med. 2018 Dec;36(12):2211-2218. doi: 10.1016/j.ajem.2018.04.004. Epub 2018 Apr 5.
Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.
This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.
In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).
This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.
菌血症是患者面临感染性休克等风险的第一阶段。本研究的主要目的是描述菌血症早期治疗链中的相关因素，以及这些因素与入院后 28 天内增加存活机会的相关性。此外，还评估了长期预后。
本研究基于急诊医疗服务（EMS）和医院记录的数据，采用定量设计。
共有 961 名患者纳入本研究。其中，13.5%的患者在入院后 28 天内死亡。非幸存者更频繁地使用 EMS。在使用 EMS 的患者中，幸存者在现场就已经更频繁地怀疑存在败血症。同样，EMS 人员在到达现场时，更频繁地为幸存者记录 ESS 代码“发热、感染”。从呼叫 EMS 到入院并开始使用抗生素的延迟时间在幸存者和非幸存者之间相似。五年死亡率为 50.8%。使用 EMS 的患者中，五年死亡率为 62.6%，未使用 EMS 的患者中，五年死亡率为 29.5%（p<0.0001）。
本研究表明，在使用 EMS 的菌血症患者中，早期怀疑败血症或发热/感染与早期生存改善相关，而从呼叫 EMS 到入院并开始使用抗生素的延迟时间与预后无关。所有患者中有 50.8%在五年后死亡。
