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Prehospital characteristics among patientswith sepsis: a comparison between patients with or without adverse outcome
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. (PreHospen)
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. (PreHospen)
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.ORCID-id: 0000-0002-9194-3244
Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden. (PreHospen)ORCID-id: 0000-0001-7865-3480
Vise andre og tillknytning
2019 (engelsk)Inngår i: BMC Emergency Medicine, E-ISSN 1471-227X, artikkel-id 19:43Artikkel i tidsskrift (Fagfellevurdert) 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.

sted, utgiver, år, opplag, sider
2019. artikkel-id 19:43
HSV kategori
Forskningsprogram
Människan i vården
Identifikatorer
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
Tilgjengelig fra: 2019-08-07 Laget: 2019-08-07 Sist oppdatert: 2024-07-04bibliografisk kontrollert
Inngår i avhandling
1. När livet plötsligt tar en ny vändning: Att förstå, hantera och identifiera allvaret vid insjuknandet i sepsis
Åpne denne publikasjonen i ny fane eller vindu >>När livet plötsligt tar en ny vändning: Att förstå, hantera och identifiera allvaret vid insjuknandet i sepsis
2022 (svensk)Doktoravhandling, med artikler (Annet vitenskapelig)
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.

sted, utgiver, år, opplag, sider
Borås: Högskolan i Borås, 2022
Serie
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 134
Emneord
Ambulance clinician, assessment, lived experiences, prehospital emergency care, sepsis, signs, symptoms, qualitative research, quantitative research
HSV kategori
Forskningsprogram
Människan i vården
Identifikatorer
urn:nbn:se:hb:diva-28792 (URN)978-91-89271-84-5 (ISBN)978-91-89271-85-2 (ISBN)
Disputas
2022-12-13, Sparbankssalen, Järnvägsgatan 1, Borås, 13:00 (svensk)
Opponent
Tilgjengelig fra: 2022-12-09 Laget: 2022-10-24 Sist oppdatert: 2022-11-25bibliografisk kontrollert

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

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