Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • harvard-cite-them-right
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. (PreHospen)
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0002-9194-3244
University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden. (PreHospen)ORCID iD: 0000-0001-7865-3480
Show others and affiliations
2019 (English)In: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, article id 19:43Article in journal (Refereed) Published
Abstract [en]

Background: The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients withseps is are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays.

Methods: This was a retrospective observational study. The patients’ electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed.

Results: In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serumglucose level and altered mental status during prehospital care were found to be associated with an adverse outcome.

Conclusions: The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.

Place, publisher, year, edition, pages
2019. article id 19:43
National Category
Infectious Medicine
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-21573DOI: 10.1186/s12873-019-0255-0ISI: 000479221700001Scopus ID: 2-s2.0-85070479554OAI: oai:DiVA.org:hb-21573DiVA, id: diva2:1341066
Available from: 2019-08-07 Created: 2019-08-07 Last updated: 2022-11-25Bibliographically approved
In thesis
1. När livet plötsligt tar en ny vändning: Att förstå, hantera och identifiera allvaret vid insjuknandet i sepsis
Open this publication in new window or tab >>När livet plötsligt tar en ny vändning: Att förstå, hantera och identifiera allvaret vid insjuknandet i sepsis
2022 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to explore the onset of sepsis and ambulance clinicians’ initial assessment of patients with sepsis.

Methods: The thesis consists of four studies where the onset and assessment are studied from different perspectives Studies I and II are qualitative descriptive studies. In study I, 24 individual and dyadic interviews with patients and/or family members were conducted. In study II, 14 individual and dyadic interviews with ambulance clinicians were conducted. Thematic analysis based on descriptive phenomenology was used in studies I and II. Studies III and IV are quantitative observational studies. In study III, 327 medical records of patients with sepsis who were cared for by ambulance clinicians were examined. In study IV, serum lactate and plasma glucose were measured prospectively in 1842 patients. Different statistical methods were used in studies III and IV to analyze the data.

Results: The onset of sepsis was experienced as an insidious illness, difficult to comprehend as something critical. As symptoms and signs worsened, it was still difficult for patients and family members to understand the seriousness of the illness. As the illness progressed, family members became more worried, and at some point realized that the patient was seriously ill. Several aspects were important for ambulance clinicians to assess and identify sepsis patients. Their assessment was influenced by previous experiences in their search for clues regarding the severity of patients’ conditions. Ambulance clinicians described that their assessment involved an ongoing search for information and a need to discuss with colleagues. Patients transported by ambulance who had more adverse outcomes following sepsis were more often found to have altered mental status, lower oxygen saturation, lower body temperatures, and higher serum glucose prior to entering the emergency department. Elevated plasma glucose and serum lactate were not found to be associated with an increased likelihood of sepsis when measured by ambulance clinicians.

Conclusion: There are challenges related to the onset and assessment of patients with sepsis, as no specific symptoms or signs can be used for early sepsis identification by ambulance clinicians. This places demands on ambulance clinicians’ clinical reasoning and ability to identify these patients. Listening to patients’ and family members' stories about the course of the disease, using previous experiences, discussing with colleagues, and observing the surrounding are important for the assessment and identification of  patients with sepsis.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2022
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 134
Keywords
Ambulance clinician, assessment, lived experiences, prehospital emergency care, sepsis, signs, symptoms, qualitative research, quantitative research
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-28792 (URN)978-91-89271-84-5 (ISBN)978-91-89271-85-2 (ISBN)
Public defence
2022-12-13, Sparbankssalen, Järnvägsgatan 1, Borås, 13:00 (Swedish)
Opponent
Available from: 2022-12-09 Created: 2022-10-24 Last updated: 2022-11-25Bibliographically approved

Open Access in DiVA

fulltext(1208 kB)154 downloads
File information
File name FULLTEXT01.pdfFile size 1208 kBChecksum SHA-512
694f32362e18360250a07e2e67901d2436ce87919ef7ce603e95ee637ab14a84e8dc55e632d86a4dca3f607416aefefe44b9420ae3ed7b8a9d4e973f96f1028d
Type fulltextMimetype application/pdf

Other links

Publisher's full textScopus

Authority records

Olander, AgnesAndersson, HenrikSundler, Annelie JohanssonBremer, AndersAndersson Hagiwara, Magnus

Search in DiVA

By author/editor
Olander, AgnesAndersson, HenrikSundler, Annelie JohanssonBremer, AndersAndersson Hagiwara, Magnus
By organisation
Faculty of Caring Science, Work Life and Social Welfare
In the same journal
BMC Emergency Medicine
Infectious Medicine

Search outside of DiVA

GoogleGoogle Scholar
Total: 154 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 215 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • harvard-cite-them-right
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf