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Table 3 Prehospital studies of sepsis

From: Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care

Ref Year Aim n Results
A. Prehospital treatment
(1) Meningococcal sepsis
23 1998 To assess the effect of antibiotics given by GP 32 Higher mortality among patients who received antibiotics
24 2002 To assess the effect of antibiotics given by GP 534 The effect of prehospital antibiotics appeared to be dependent on hospital care
25 2006 To explore mortality and morbidity after parenteral penicillin in children 158 Children who were given antibiotics had a more severe disease on admission to hospital
26 2005 Audit to determine the clinical appropriateness of administrations of benzyl penicillin by paramedics 69 Paramedic compliance with guidelines was low (78% failures)
(2) Fluids
36 2010 To determine the delivery of out-of -hospital fluids in severe sepsis 52 Forty-eight per cent received intravenous fluids
B. Impact of EMS on care of sepsis patients
32 2010 To evaluate early recognition and treatment in relation to EMS care 311 Patients who used the EMS had more organ failure but a shorter time to antibiotics and EGDT
33 2010 To characterise patients with sepsis in relation to the use of the EMS 4,613 EMS patients were more likely to present with severe sepsis
34 2010 To describe out-of-hospital characteristics and EMS care among patients with severe sepsis who used the EMS 216 Out-of-hospital variables were associated with organ dysfunction at the ED
42 2011 To assess the impact of the EMS on time to antibiotics, intravenous fluids and mortality in severe sepsis 963 Out-of-hospital care was associated with improved in-hospital processes but not mortality
C. Prediction of outcome
39 2009 To consider how prehospital staff can improve the outcome in severe sepsis   The article suggests that antibiotics should be given in the prehospital setting and that lactate should be measured
35 2007 To assess the predictive effect of physiological elements commonly reported in the out-of-hospital setting on the outcome in severe sepsis 63 The out-of-hospital shock index and respiratory rate are highly predictive of ICU admission
D. Knowledge and attitudes regarding sepsis among EMS staff
38 2010 To assess the knowledge and attitudes in the diagnosis and management of sepsis in the USA 226 Poor understanding of the principles of diagnosis and management of sepsis was observed
  1. GP = General practitioner.
  2. EMS = Emergency Medical Services.
  3. EGDT = Early Goal Directed Therapy.
  4. ED = Emergency Department.