Emergency medical services identification of sepsis
| Study | Predictor(s) evaluated | Reference standard | Sensitivity (95% CI) | Specificity (95% CI) |
|---|---|---|---|---|
| Asayama and Aikawa13 | SIRS (T >38 or <36, HR>90, RR>20, WBC<4000 or >12 000) | Treatment for infection | 0.73 (0.60 to 0.84) | 0.87 (0.86 to 0.89) |
| Bayer et al18 | Vital signs (T >38 or <36, pCO2<4.3 kPa, HR>90, RR>22, WBC) PRESEP score | Dual MD consensus on diagnosis | PRESEP score: 0.85 (0.76 to 0.92) | PRESEP Score*: 0.86 (0.82 to 0.90) |
| Groenewoudt et al19 | Provider impression | MD diagnosis in ED | 0.63 (0.58 to 0.69) | Unable to calculate |
| Guerra et al14 | Sepsis alert protocol (T >38 or <36, HR>90, RR>20, WBC <4000 or >12 000, SBP<90, MAP<65, lactate≥4) Provider impression | ICD-9 for infection plus 2 SIRS | Sepsis alert protocol: 0.48 (0.35 to 0.60) Provider impression: 0.10 (0.03 to 0.22) | Unable to calculate |
| Polito et al17 | Vital signs (HR>90, RR>20), SBP<110, PRESS score | MD diagnosis within 48 h | PRESS score: 0.87 (0.77 to 0.93) Provider impression: 0.19 (0.11 to 0.29) | PRESS Score*: 0.43 (0.39 to 0.48) Provider Impression: Unable to Calculate |
| Seymour et al8 | Vital signs (SBP≤90, RR>36, GCS≤11, SpO2<88, HR≥120) | MD diagnosis with lactate measured | SBP: 0.19 (0.18 to 0.19) RR: 0.14 (0.13 to 0.14) GCS: 0.13 (0.12 to 0.13) SpO2: 0.10 (0.10 to 0.11) HR: 0.21 (0.20 to 0.22) | Unable to calculate |
| Studnek et al12 | Provider impression | MD diagnosis in ED | 0.21 (0.15 to 0.28) | Unable to calculate |
| Suffoletto et al15 | Vital signs (HR>90, RR>20, SBP<100, SpO2<95) Presence of fever Provider impression | MD diagnosis in ED | Vital signs†+ provider impression: 0.50 (0.32 to 0.68) SBP: 0.28 (0.14 to 0.47) Fever: 0.25 (0.12 to 0.43) Provider impression: 0.31 (0.16 to 0.50) | Vital signs†+Provider Impression: 0.83 (0.77 to 0.88) SBP: 0.88 (0.82 to 0.93) Fever: 0.95 (0.90 to 0.98) Provider Impression: 0.93 (0.88 to 0.96) |
| Wallgren et al16 | Robson tool: (T>38.3 or <36, HR>90, RR>20, Acute altered LOC, glucose >6.6 mmol/L) BAS tool: (SBP<90, RR>30, SpO2<90) Provider impression | ICD-9 for sepsis | Robson tool: 0.75 (0.53 to 0.90) BAS tool: 0.43 (0.36 to 0.51) Provider impression: 0.11 (0.08 to 0.14) | Unable to calculate |
*Total patient population restricted to exclude patients unlikely to have sepsis during EMS care (ex. trauma, cardiac arrest).
†Only included variables that were significant for predicting ‘serious infection’ (SBP and fever).ED, emergency department; EMS, emergency medical services; HR, heart rate; ICD-9, International Classification of Diseases ninth edition; LOC, level of consciousness; MAP, mean arterial pressure; MD, medical doctor; SBP, systolic BP; SIRS, systemic inflammatory response syndrome; SpO2, oxygen saturation; T, temperature; WBC, white blood cell.