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treatment
management
clinical skills
assessment
respiratory conditions

A pilot study exploring the accuracy of pre-hospital sepsis recognition in the North East Ambulance Service

02 September 2015
Features
02 September 2015
Volume 7 · Issue 9

Abstract

Background:

Over the past decade there has been a focus on improving pre-hospital recognition and treatment of patients with sepsis. This pilot study investigates pre-hospital sepsis recognition, including the use of a Sepsis Screening Tool (SST), treatment and whether timely identification influenced the time to treatment and outcome at the receiving unit.

Methods:

A cross-sectional sample of patients with a documented suspicion of sepsis by North East Ambulance Service NHS Foundation Trust (NEAS) was combined and cross referenced with patients coded for sepsis at The James Cook University Hospital (JCUH) to generate a sample of sepsis patients seen within January 2014. NEAS sepsis recognition was compared with SST identification by retrospectively examining patients' medical records. Sensitivity and specificity for NEAS diagnosis were calculated by comparing NEAS identification with JCUH diagnosis using the hospital SST.

Results:

The sample included 49 patients from January 2014. NEAS correctly identified 18/42 patients with sepsis (43% sensitivity, 14% specificity). NEAS correctly identified 8/27 patients with severe sepsis (30% sensitivity, 77% specificity).

Conclusions:

It is evident that NEAS clinicians diagnose sepsis without consistently using the SST. Use of the SST would improve the ability of NEAS clinicians to identify patients with sepsis.

This pilot study will explore sepsis recognition by North East Ambulance Service NHS Foundation Trust (NEAS), estimate the sensitivity and specificity of paramedic identification of sepsis and examine use of the Sepsis Screening Tool (SST) (See Appendix 1).

NEAS trained all clinical staff in sepsis recognition using the SST between April 2012 and March 2013 in order to improve awareness, detection and treatment of this previously ill-defined condition. Sepsis was covered in a 1-hour session, during the two-day essential annual training. The SST is based on the tool developed by the UK Sepsis Trust (UKST) and adapted locally by the North East Critical Care Network (NECCN) but has not been validated in a pre-hospital setting. The SST was updated in June 2014, in line with recommendations from the NECCN, to include oxygen saturations as a trigger of organ dysfunction. The updated version is referred to as SST+.

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Identification
Pre-hospital
Sepsis
Severe sepsis
Screening