Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Intensive Care Med. 2020 Jul;46(7):1394-1403. doi: 10.1007/s00134-020-06093-4. Epub 2020 May 28.
Paramedics are often the first healthcare contact for patients with infection and sepsis and may identify them earlier with improved knowledge of the clinical signs and symptoms that identify patients at higher risk.
A 1-year (April 2015 and March 2016) cohort of all adult patients transported by EMS in the province of Alberta, Canada, was linked to hospital administrative databases. The main outcomes were infection, or sepsis diagnosis among patients with infection, in the Emergency Department. We estimated the probability of these outcomes, conditional on signs and symptoms that are commonly available to paramedics.
Among 131,745 patients transported by EMS, the prevalence of infection was 9.7% and sepsis was 2.1%. The in-hospital mortality rate for patients with sepsis was 28%. The majority (62%) of patients with infections were classified by one of three dispatch categories ("breathing problems," "sick patient," or "inter-facility transfer"), and the probability of infection diagnosis was 17-20% for patients within these categories. Patients with elevated temperature measurements had the highest probability for infection diagnosis, but altered Glasgow Coma Scale (GCS), low blood pressure, or abnormal respiratory rate had the highest probability for sepsis diagnosis.
Dispatch categories and elevated temperature identify patients with higher probability of infection, but abnormal GCS, low blood pressure, and abnormal respiratory rate identify patients with infection who have a higher probability of sepsis. These characteristics may be considered by paramedics to identify higher-risk patients prior to arrival at the hospital.
急救人员通常是感染和败血症患者的第一医疗接触者，通过提高对识别高危患者的临床体征和症状的认识，他们可能更早地识别出这些患者。
对 2015 年 4 月至 2016 年 3 月期间在加拿大艾伯塔省通过急救医疗服务转运的所有成年患者进行了为期 1 年的队列研究，并将这些患者与医院行政数据库进行了关联。主要结局是在急诊科对感染患者的感染或败血症诊断。我们根据急救人员通常可获得的体征和症状，对这些结局发生的可能性进行了估计。
在通过急救医疗服务转运的 131745 例患者中，感染的患病率为 9.7%，败血症为 2.1%。败血症患者的院内死亡率为 28%。大多数（62%）感染患者属于三个调度类别之一（“呼吸问题”、“生病患者”或“机构间转运”），这些类别的患者的感染诊断概率为 17-20%。体温升高的患者感染诊断的可能性最高，但格拉斯哥昏迷量表（GCS）异常、低血压或呼吸频率异常的患者败血症诊断的可能性最高。
调度类别和体温升高可识别出感染可能性较高的患者，但异常的 GCS、低血压和异常的呼吸频率可识别出感染可能性较高的败血症患者。这些特征可被急救人员用于在到达医院之前识别高风险患者。
