7 Ambulance patients with sepsis: a seriously ill population
Groenewoudt, M., Leijten, F.M.M., Stassen, P.M.
Locatie(s): Zaal 0.11
Categorie(ën): Parallelsessie
Introduction: Sepsis is a major problem with high mortality. The surviving sepsis campaign aims to reduce this mortality and provides treatment guidelines that emphasize the need of early start of treatment. However, treatment of sepsis patients before arriving at the hospital is not considered in these guidelines. Transportation by ambulance may offer an opportunity to start treatment early.
Aim of the study: This study investigated how many patients with sepsis are transported by ambulance, whether sepsis is recognised by the ambulance staff and how these patients are assessed and treated in the ambulance. Further we compared patients who are transported by the ambulance with those who are not, regarding demographic data, hospitalisation and outcome.
Materials and Methods: All patients with sepsis who were assessed by an internist at the emergency department of our secondary and tertiary hospital between March 2011 and March 2012 were prospectively included in our study. Data from patient charts were completed with data from the ambulance service.
Results: In the one-year study period, 664 patients with sepsis were included. Almost half (47.6%) of the patients had been transported by ambulance. These patients were significantly older (71 vs. 56 years), had more severe grades of sepsis and were admitted more frequently to the hospital (96 vs. 86%) and to the intensive care unit (7.0 vs. 0.6%) than the other sepsis patients. Mortality within 28 days was 19.4% in the ambulance patients compared to 6.3% in the other patients. Sepsis or infection was recognized in the ambulance in 74.3% of the patients. Half of the ambulance rides were considered non urgent, even in 34.6% of the patients with septic shock. Assessments of vital signs were not routinely performed and treatment was started in only 43.7%.
Conclusion: Almost half of the sepsis patients who are assessed by the internist at the emergency department are transported by ambulance. These patients are seriously ill with a mortality of 19.4%, but are often transported with non urgent rides and assessment of vital signs and early start of treatment are not routinely performed. The ambulance offers an opportunity for early start of treatment. However, recognition and acknowledgment of the seriousness of sepsis must be improved.