Severe Sepsis in Pre-Hospital Emergency Care Analysis of Incidence, Care, and Outcome
Severe Sepsis in Pre-Hospital Emergency Care Analysis of Incidence, Care, and Outcome
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DOI：
10.1164/rccm.201204-0713oc
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发表时间：
2012-12-15
影响因子：
24.7
通讯作者：
Angus, Derek C.
中科院分区：
文献类型：
--
作者：
Seymour, Christopher W.;Rea, Thomas D.;Angus, Derek C.
理由：严重脓毒症是常见和高度病态的，但在卫生保健系统的前沿严重脓毒症的流行病学-院前急救-是未知的。目的：研究急诊医疗服务（EMS）患者院前严重脓毒症与急性心肌梗死和中风的流行病学关系。方法：采用基于社区的队列进行回顾性研究，研究对象为2000年至2009年被送往医院的所有金县EMS非骤停、非创伤患者。测量方法和主要结果：EMS患者因严重脓毒症住院的总发生率、院前特征、入院诊断和转归。在407,176例急诊就诊中，我们发现13,249例因严重败血症住院，其中2,596例在医院死亡（19.6%）。严重脓毒症的粗发生率为3.3 / 100次EMS就诊，高于急性心肌梗死或中风（分别为2.3 / 100次和2.2 / 100次）。超过40%的严重脓毒症住院患者是在EMS转运后到达急诊科的，80%的病例在入院时被诊断出来。对于严重败血症住院患者，院前护理间隔平均超过45分钟。一半或更少的严重脓毒症患者由护理人员运送（n = 7,114; 54%）或接受院前静脉通路（n = 4,842; 37%）。结论：EMS人员对大量且越来越多的严重脓毒症患者进行护理，并且在现场和运输过程中花费了大量时间。鉴于对脓毒症的快速诊断和干预的重视，院前间隔可能是脓毒症识别和护理的重要机会。
Rationale: Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care system-pre-hospital emergency care-is unknown.Objectives: We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke.Methods: Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital.Measurements and Main Results: Overall incidence rate of hospitalization with severe sepsis among EMS encounters, as well as pre-hospital characteristics, admission diagnosis, and outcomes. Among 407,176 EMS encounters, we identified 13,249 hospitalizations for severe sepsis, of whom 2,596 died in the hospital (19.6%). The crude incidence rate of severe sepsis was 3.3 per 100 EMS encounters, greater than for acute myocardial infarction or stroke (2.3 per 100 and 2.2 per 100 EMS encounters, respectively). More than 40% of all severe sepsis hospitalizations arrived at the emergency department after EMS transport, and 80% of cases were diagnosed on admission. Pre-hospital care intervals, on average, exceeded 45 minutes for those hospitalized with severe sepsis. One-half or fewer of patients with severe sepsis were transported by paramedics (n = 7,114; 54%) or received pre-hospital intravenous access (n = 4,842; 37%).Conclusions: EMS personnel care for a substantial and increasing number of patients with severe sepsis, and spend considerable time on scene and during transport. Given the emphasis on rapid diagnosis and intervention for sepsis, the pre-hospital interval may represent an important opportunity for recognition and care of sepsis.