Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study

Purpose Early recognition and treatment in severe sepsis improve outcomes However, out of-hospital patient characteristics and emergency medical services (EMS) ewe in severe sepsis is understudied Our goals were to describe out-of hospital characteristics and EMS care in patients with severe sepsis and to evaluate associations between out-of hospital characteristics and seventy of organ dysfunction in the emergency department (ED) Materials and Methods We performed a secondary data analysis of existing data from patients with severe sepsis transported by EMS to an academic medical center We constructed multivariable linear regression models to determine if out of-hospital factors are associated with serum lactate and sequential organ failure assessment (SOFA) in the ED Results Two hundred sixteen patients with severe sepsis arrived by EMS Median serum lactate in the ED was 3 0 mmol/L (interquartile range 2 0-5 0) and median SOFA score was 4 (interquartile range 2 6) Sixty-three percent (135) of patients were transported by advanced life support providers and 30% (62) received Intravenous fluid Lower out-of-hospital Glasgow Coma Scale score was independently associated with elevated serum lactate (P < 01) Out-of hospital hypotension, greater respiratory rate, and lower Glasgow Coma Scale score were associated with greater SOFA (P < 01) Conclusions Out of-hospital fluid resuscitation occurred in less than one third of patients with severe sepsis, and routinely measured out of hospital variables were associated with greater serum lactate and SOFA in the ED (C) 2010 Elsevier Inc All rights reserved