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Observational Study
. 2024 Oct 8;24(1):180.
doi: 10.1186/s12873-024-01098-4.

The performance of screening tools and use of blood analyses in prehospital identification of sepsis patients and patients suitable for non-conveyance - an observational study

Agnes Olander  1   2   3 , Lina Frick  4 , Jennifer Johansson  4 , Kristoffer Wibring  5   6   7
Affiliations
Observational Study

The performance of screening tools and use of blood analyses in prehospital identification of sepsis patients and patients suitable for non-conveyance - an observational study

Agnes Olander et al. BMC Emerg Med. .

Abstract

Background: Early recognition of sepsis by the EMS (Emergency Medical Services), along with communicating this concern to the emergency department, could improve patient prognosis and outcome. Knowledge is limited about the performance of sepsis identification screening tools in the EMS setting. Research is also limited on the effectiveness of prehospital use of blood tests for sepsis identification. Integrating blood analyses with screening tools could improve sepsis identification, leading to prompt interventions and improved patient outcomes.

Aim: The aim of the present study is firstly to evaluate the performance of various screening tools for sepsis identification in the EMS setting and secondly to assess the potential improvement in accuracy by incorporating blood analyses.

Methods: This is a retrospective observational cohort study. The data were collected from prehospital and hospital medical records in Region Halland. Data on demographics, vital signs, blood tests, treatment, and outcomes were collected from patients suspected by EMS personnel of having infection. The data were analysed using Student's t-test. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were used to indicate accuracy and predictive value.

Results: In total, 5,405 EMS missions concerning 3,225 unique patients were included. The incidence of sepsis was 9.8%. None of the eleven tools included had both high sensitivity and specificity for sepsis identification. White blood cell (WBC) count was the blood analysis with the highest sensitivity but the lowest specificity for identifying sepsis. Adding WBC, C-reactive protein (CRP) or lactate to the National Early Warning Score (NEWS) increased the specificity to > 80% but substantially lowered the sensitivity.

Conclusions: Identifying sepsis in EMS settings remains challenging, with existing screening tools offering limited accuracy. CRP, WBC, and lactate blood tests add minimal predictive value in distinguishing sepsis or determining non-conveyance eligibility.

Keywords: Ambulance services; Blood specimen; Blood test; Emergency medical services; Prehospital; Screening; Sepsis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
See this image and copyright information in PMC

References

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