Abstract
Objective
To derive and validate a predictive model and novel emergency medical services (EMS)
screening tool for severe sepsis (SS).
Design
Retrospective cohort study.
Setting
A single EMS system and an urban, public hospital.
Patients
Sequential adult, nontrauma, nonarrest, at-risk, EMS-transported patients between
January 1, 2011, and December 31, 2012 were included in the study. At-risk patients
were defined as having all 3 of the following criteria present in the EMS setting:
(1) heart rate greater than 90 beats/min, (2) respiratory rate greater than 20 beats/min,
and (3) systolic blood pressure less than 110 mm Hg.
Interventions
None.
Measurements and Main Results
Among 66,439 EMS encounters, 555 met the criteria for analysis. Fourteen percent (n
= 75) of patients had SS, of which 19% (n = 14) were identified by EMS clinical judgment.
In-hospital mortality for patients with SS was 31% (n = 23). Six EMS characteristics
were found to be predictors of SS: older age, transport from nursing home, Emergency
Medical Dispatch (EMD) 9-1-1 chief concern category of “sick person,” hot tactile
temperature assessment, low systolic blood pressure, and low oxygen saturation. The
final predictive model showed good discrimination in derivation and validation subgroups
(areas under curves, 0.843 and 0.820, respectively). Sensitivity of the final model
was 91% in the derivation group and 78% in the validation group. At a predefined threshold
of 2 or more points, prehospital severe sepsis (PRESS) score sensitivity was 86%.
Conclusions
The PRESS score is a novel EMS screening tool for SS that demonstrates a sensitivity
of 86% and a specificity of 47%. Additional validation is needed before this tool
can be recommended for widespread clinical use.
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Article Info
Publication History
Published online: April 22, 2015
Accepted:
April 15,
2015
Received in revised form:
March 21,
2015
Received:
January 6,
2015
Footnotes
☆Funding support: C.P. and this work are supported by the National Institutes of Health ( T32GM095442 and UL1TR000454 ).
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
