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. 2020 Jun 27;1(3):169-177.
doi: 10.36518/2689-0216.1063. eCollection 2020.

Prehospital Antibiotics Improve Morbidity and Mortality of Emergency Medical Service Patients with Sepsis

Thomas Martel  1 , Monica N Melmer  1 , Samuel M Leaman  2 , Nicole Kassen  1 , Seth Kozlowski  1 , Jonathan Pangia  1 , Scott Gutovitz  1 , Dietrich Jehle  1
Affiliations

Prehospital Antibiotics Improve Morbidity and Mortality of Emergency Medical Service Patients with Sepsis

Thomas Martel et al. HCA Healthc J Med. .

Abstract

Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis.

Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality between these groups.

Results: Early antibiotics and fluids were demonstrated to show significant improvement in outcomes in the patients meeting sepsis criteria treated in the pre-hospital setting. The average age for sepsis patients receiving antibiotics in the prehospital setting was statistically higher than that for patients in the historical control group, 73.23 years and 67.67, respectively (p < 0.036), and there was no statistically significant difference of Charlson Comorbidity Index between the groups (p two-tail = 0.28). Average intensive care unit length of stay was 2.51 days in the in the prehospital group and 5.18 days in the historical controls, and the prehospital group received fewer blood products than the historical controls (p = 0.0003).

Conclusions: Early IV administration of antibiotics in the field significantly improves outcome in EMS patients who meet sepsis criteria based on a modified qSOFA score.

Keywords: Emergency Medical Services; antibiotic prophylaxis; antibiotics; emergency treatment; prehospital; retrospective studies; sepsis/diagnosis; sepsis/therapy; time factors.

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Conflict of interest statement

Conflicts of Interest The authors declare they have no conflicts of interest.

Figures

Figure 1
Figure 1
Sepsis protocol for EMS administration of antibiotics. EKG = electrocardiogram; BGL = blood glucose level; SBP = systolic blood pressure; IV = intravenous; EMS = emergency medicine services
Figure 2
Figure 2
Comparison of in-hospital mortality between the study cohort (n=47) and historical controls (n=298). We found a reduction in mortality among the study cohort (n=4) compared to the historical control (n=76), (χ2 = 6.582; p = 0.01).
Figure 3
Figure 3
Average hospital and ICU length of stay for study cohort versus historical controls. The study group had a significantly shorter ICU length of stay (2.51 days [95% CI, 0.28 – 4.74] vs 5.18 days [95% CI, 4.31 – 6.06]), two-sample t-test p = 0.03*.
Figure 4
Figure 4
Blood culture contamination rates by emergency medical services (EMS) and nursing providers for the study cohort. The number of contaminated blood cultures was derived by hospital lab technicians’ charting of possible contamination. There was no statistical difference between the rates of contamination (Fisher’s exact test, p = 0.16).
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