Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave, Maywood, IL 60153, United States.
Department of Emergency Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, United States.
Am J Emerg Med. 2019 Aug;37(8):1428-1432. doi: 10.1016/j.ajem.2018.10.036. Epub 2018 Oct 20.
The Surviving Sepsis Campaign implemented a 3-hour bundle including blood cultures, lactate, intravenous fluids, and antibiotics to improve mortality in sepsis. Though difficult to achieve, bundle compliance is associated with decreased hospital mortality. We predict that the implementation of an Emergency Medical Services (EMS) sepsis screening tool will improve 3-hour bundle compliance.
To determine if pre-hospital sepsis screening improves 3-hour bundle compliance.
Prospective implementation of an EMS sepsis screening tool (June 2016-November 2016) was compared to a historical control (August 2015-March 2016). The protocol was facilitated via communication between nurses and EMS personnel. The primary outcome was 3-hour bundle compliance. Secondary outcomes included time to individual bundle components.
Of 135 patients screened, 20 were positive and included in the study, and subsequently compared to 43 control patients. Baseline demographics were similar, except median Sequential Organ Failure Assessment (SOFA) score was higher for the pre-EMS tool group (5 [interquartile range (IQR) 2-8] vs. 2 [IQR 1-4], p < 0.01). Three-hour bundle compliance was significantly higher in the EMS tool group (80% vs. 44.2%, p < 0.01). The pre-EMS tool group had lower median time to lactate (15 [IQR 0-35] vs. 46 min [IQR 34-57], p < 0.001), 30 mL/kg IV fluids (6.5 [IQR 0-38] vs. 46 min [IQR 27.5-72], p < 0.001), and, although not significant, antibiotics (63.5 [IQR 44-92] vs. 72 min [IQR 59.5-112], p = 0.26).
Implementation of an EMS sepsis screening tool resulted in improved 3-hour bundle compliance compared to retrospective control.
拯救脓毒症运动实施了一个 3 小时的捆绑包，包括血液培养、乳酸、静脉输液和抗生素，以提高脓毒症患者的死亡率。虽然难以实现，但捆绑包的依从性与降低医院死亡率有关。我们预测，实施紧急医疗服务（EMS）脓毒症筛查工具将提高 3 小时捆绑包的依从性。
确定院前脓毒症筛查是否能提高 3 小时捆绑包的依从性。
前瞻性实施 EMS 脓毒症筛查工具（2016 年 6 月至 2016 年 11 月）与历史对照（2015 年 8 月至 2016 年 3 月）进行比较。该方案通过护士和 EMS 人员之间的沟通来促进。主要结局是 3 小时捆绑包的依从性。次要结局包括各个捆绑包组件的时间。
在 135 名接受筛查的患者中，有 20 名呈阳性并纳入研究，随后与 43 名对照组患者进行比较。基线人口统计学特征相似，但前 EMS 工具组的中位序贯器官衰竭评估（SOFA）评分较高（5[四分位距（IQR）2-8]比 2[IQR 1-4]，p<0.01）。EMS 工具组的 3 小时捆绑包依从性明显更高（80%比 44.2%，p<0.01）。前 EMS 工具组的乳酸中位时间更短（15[IQR 0-35]比 46 分钟[IQR 34-57]，p<0.001），30ml/kg 静脉输液中位数时间更短（6.5[IQR 0-38]比 46 分钟[IQR 27.5-72]，p<0.001），尽管不显著，但抗生素中位时间也更短（63.5[IQR 44-92]比 72 分钟[IQR 59.5-112]，p=0.26）。
与回顾性对照相比，实施 EMS 脓毒症筛查工具可提高 3 小时捆绑包的依从性。
