BMC Emergency Medicine最新文献

{"title":"Can ketamine administration prevent intubation in patients who cannot comply with NIV due to agitation?","authors":"Çağatay Nuhoğlu, Görkem Alper Solakoğlu, Ferhat Arslan, Ömer Faruk Gülsoy, Kamil Oğuzhan Döker","doi":"10.1186/s12873-024-01100-z","DOIUrl":"10.1186/s12873-024-01100-z","url":null,"abstract":"<p><strong>Background: </strong>In patients presenting to the emergency department (ED) with acute respiratory failure, non-invasive mechanical ventilation (NIMV) is applied when conventional oxygen support is not sufficient. Patients who are agitated often have very low NIMV compliance and a transition to invasive mechanical ventilation (IMV) is often required. To avoid IMV, a suitable sedative agent can be utilized. The aim of this research is to investigate the relationship between ketamine administration to patients who are non-compliant with NIMV due to agitation and the outcome of their intubation.</p><p><strong>Methods: </strong>This retrospective study included patients with acute respiratory failure who were admitted to the ED from 2021 to 2022 and used Richmond Agitation Sedation Scale (RASS) to identify agitation level of patients. The relationship between ketamine administration in this patient group and NIMV compliance and intubation rate was evaluated.</p><p><strong>Results: </strong>A total of 81 patients, including 35 (43.2%) men and 46 (56.8%) women, were included in the study. Of these patients, 46 (56.8%) were intubated despite ketamine administration, while 35 (43.2%) were compliant with NIMV and were not intubated. When evaluating the RASS, which shows the agitation levels of the patients, the non-intubated group was found to be 2.17 ± 0.68, while the intubated group was 2.66 ± 0.73, and it was statistically significant that the NIMV intubated group was higher (p = 0.003).</p><p><strong>Conclusion: </strong>This study showed that agitation can impair NIMV compliance in patients with acute respiratory failure. However, a significant proportion of this patient group can be avoided through IMV with proper sedative agents.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"187"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for implementation of a transmural fall-prevention care pathway for older adults with fall-related injuries at the emergency department.","authors":"W M Charmant, B A M Snoeker, H P J van Hout, E Geleijn, N van der Velde, C Veenhof, P W B Nanayakkara","doi":"10.1186/s12873-024-01085-9","DOIUrl":"10.1186/s12873-024-01085-9","url":null,"abstract":"<p><strong>Background: </strong>Although indicated, referrals for multifactorial fall risk assessments in older adults with fall related injuries presenting at the emergency department (ED) are not standard. The implementation of a transmural fall-prevention care pathway (TFCP) could bridge this gap by guiding patients to multifactorial fall risk assessments and personalised multidomain interventions in primary care. This study aims to develop and evaluate implementation strategies for a TFCP.</p><p><strong>Methods: </strong>In this mixed-methods implementation study, strategies were developed using the Consolidated Framework for Implementation Research Expert Recommendations for Implementing Change Matching Tool. These were evaluated with patients, involved healthcare professionals, and other stakeholders using the Reach, Adoption, Implementation, and Maintenance of the RE-AIM framework in two cycles. Patients of the TFCP consisted of frail community dwelling individuals aged 65 and over presenting at the ED with fall related injuries.</p><p><strong>Results: </strong>During the first implementation phase, strategies were focussed on assessing readiness, adaptability, local champions, incentives and education for all involved healthcare professions in the TFCP. Only 34.4% of eligible patients were informed of the TFCP at the ED, 30.6% agreed to a fall risk assessment and 8.3% patients received the fall risk assessment. In the second phase, this improved to 67.1%, 64.6%, and 35.4%, respectively. Strategies in this phase focussed on adaptability, obtaining sustainable financial resources, local champions, assessing readiness, and education. The implementation was facilitated by strategies related to awareness, champion recruitment, educational meetings, adaptability of TFCP elements and evaluations of facilitators and barriers.</p><p><strong>Conclusion: </strong>The study outlined strategies for implementing TFCPs in EDs. Strategies included increasing awareness, utilising local champions, educational initiatives, adaptability of the TFCP, and continuous monitoring of facilitators and barriers. These insights can serve as a blueprint for enhancing fall prevention efforts for older adults in emergency department settings.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"188"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study.","authors":"Preeti Gupta, Anoop Mayampurath, Tim Gruenloh, Madeline Oguss, Askar Safipour Afshar, Michael Spigner, Megan Gussick, Matthew Churpek, Todd Lee, Majid Afshar","doi":"10.1186/s12873-024-01109-4","DOIUrl":"10.1186/s12873-024-01109-4","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"186"},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Psychometric properties of the Farsi version of the disaster nursing readiness evaluation index (F-DNREI).","authors":"Reza Ghanei Gheshlagh, Arvin Barzanji, Faezeh Amini, Hosein Zahednezhad","doi":"10.1186/s12873-024-01111-w","DOIUrl":"10.1186/s12873-024-01111-w","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"183"},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influences on the duration and success of out-of-hospital resuscitation of geriatric patients over 80 years of age - a retrospective evaluation.","authors":"Nils Heuser, Dennis Rupp, Susanne Glass, Martin Christian Sassen, Astrid Morin, Christian Volberg","doi":"10.1186/s12873-024-01099-3","DOIUrl":"10.1186/s12873-024-01099-3","url":null,"abstract":"<p><strong>Background: </strong>Society is experiencing an increasing shift in the age distribution and accordingly, increased resuscitation rates of patients over 80 years and older. In 2022, more than 34% of people resuscitated in Germany were older than 80 years, although older age is considered a poor predictor for the outcome of cardiopulmonary resuscitation (CPR). Professional societies provide ethical recommendations on when resuscitation may be considered futile and should be terminated. However, the extent to which these recommendations are implemented is unclear.</p><p><strong>Methods: </strong>Retrospective evaluation of pre-hospital documentation of out-of-hospital resuscitations in patients ≥ 80 years of age in the period 01/01/2014-12/31/2022 in one German county combined with data of the German Resuscitation Registry. For statistical testing, the significance level was set at p < 0.05.</p><p><strong>Results: </strong>In total 578 cases were analyzed. Return of spontaneous circulation (ROSC): 26% (n = 148). Survival to discharge: 6.1% (n = 35). Median CPR duration: 17 min (10-28 min). The older the patients were, the worse the survival rate (p = 0.05) and the shorter the time to termination (p < 0.0001). No patient over 90 years of age was discharged alive. Resuscitation was also significantly shorter until termination with poorer ASA (American Society of Anesthesiologists) score (p < 0.001). Residents resuscitated significantly longer than specialists (p = 0.02). In surviving patients, there was a significant correlation between short CPR duration and good cerebral performance category (CPC) value: Median CPC1/2 = 5 min [3-10 min] vs. CPC 3/4 = 18 min [10-21 min]; p = 0.01.</p><p><strong>Interpretation: </strong>Old age and poor health status is associated with shorter CPR duration until termination and older age is associated with poorer prognosis in out-of-hospital cardiac arrest (OHCA) concerning the possibility of return of spontaneous circulation (ROSC) and survival. A short resuscitation time is associated with a better CPC value. Therefore, when resuscitating patients over 80 years of age, even greater care should be taken to ensure that reversible causes are quickly corrected in order to achieve a ROSC and a good neurological outcome. Alternatively, resuscitation should be terminated promptly, as good survival can no longer be guaranteed. Resuscitation lasting more than 20 min should be avoided in any case, in line with the termination of resuscitation (ToR) criteria.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"184"},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study.","authors":"Maral Yazici, Ahmet Sefa Yeter, Sinan Genç, Ayça Koca, Ahmet Burak Oğuz, Müge Günalp Eneyli, Onur Polat","doi":"10.1186/s12873-024-01101-y","DOIUrl":"10.1186/s12873-024-01101-y","url":null,"abstract":"<p><strong>Background: </strong>Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient's status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.</p><p><strong>Methods: </strong>This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered \"medical emergency conditions\". The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.</p><p><strong>Results: </strong>A total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd's Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.</p><p><strong>Conclusion: </strong>Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"185"},"PeriodicalIF":2.3,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11468850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between pre-procedural anxiety and vomiting in children who undergo procedural sedation and analgesia in the emergency department.","authors":"Elham Mahmoodi, Seyed Hossein Seyed Hosseini Davarani, Sarah Yang, Mohammad Jalili, Shabnam Mohammadian, Hadi Mirfazaelian","doi":"10.1186/s12873-024-01097-5","DOIUrl":"10.1186/s12873-024-01097-5","url":null,"abstract":"<p><strong>Introduction: </strong>Children presenting to the emergency department (ED) often require procedural sedation and analgesia (PSA) prior to procedures. Although ketamine is used widely for PSA safely, there is a risk of adverse effects. Among them, vomiting is significant as it occurs in about 10% of patients and can potentially endanger the airway. Because there is evidence that post-operative complications might be due to anxiety prior to the operation, this study aims to investigate the association between pre-procedural anxiety and vomiting in the ED.</p><p><strong>Methods: </strong>In this cohort study, a convenient sample of children aged 2 to 14 years who were a candidate for PSA with ketamine in the ED were enrolled. Anxiety was evaluated using the short version of the modified Yale preoperative anxiety scale (mYAS). Vomiting was recorded during the period of hospitalization in the ED and 24 h after discharge by a phone call. Association between anxiety level and vomiting was analyzed using the independent samples t-test and multivariable logistic regression was used to control for covariates.</p><p><strong>Results: </strong>102 children were enrolled and 93 were included in final analysis. The mean age of participants was 3.95 ± 1.79 years and 55.9% were male. According to the mYAS, the mean score of anxiety was 48.67 ± 21.78 in the waiting room and 59.10 ± 23.86 in the operating room. The mean score of anxiety was 58.3±25.3 and 51.0±20.7 in the vomiting and non-vomiting groups, respectively. At least one episode of vomiting was reported in 23 children of which, 19 took place in the hospital and 4 after discharge. No significant association was observed between pre-procedural anxiety and the occurrence of vomiting. On univariate regression model, the odds ratio of the association between mean anxiety and vomiting was 1.02 (CI 95%: 0.99-1.04) (P-value: 0.16). On the multivariable logistic regression model, after adjusting for all the covariates, the odds ratio was 1.03 (CI 95%: 1.0-1.05) (P-value: 0.05).</p><p><strong>Conclusion: </strong>The present study showed that anxiety before procedural sedation and analgesia with ketamine in children was not associated with the incidence of vomiting.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"182"},"PeriodicalIF":2.3,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veno-arterial extracorporeal membrane oxygenation uses in trauma: a retrospective analysis of the Japanese nationwide trauma registry.","authors":"Tomohiro Akutsu, Akira Endo, Ryo Yamamoto, Kazuma Yamakawa, Keisuke Suzuki, Hiromasa Hoshi, Yasuhiro Otomo, Koji Morishita","doi":"10.1186/s12873-024-01096-6","DOIUrl":"10.1186/s12873-024-01096-6","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (V-A ECMO) using data from a Japanese nationwide trauma registry.</p><p><strong>Methods: </strong>This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using V-A ECMO were assessed.</p><p><strong>Results: </strong>Among the 72,439 patients with severe trauma, 51 received V-A ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25-39) and 25 (range, 17-33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4%) patients, respectively. However, these procedures were not performed in the survivor group. Peripheral oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital.</p><p><strong>Conclusions: </strong>The results of this study suggest the potential benefit of V-A ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for V-A ECMO in patients with trauma.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"179"},"PeriodicalIF":2.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and toxicological spectrum analysis of 493 cases of acute poisoning in children.","authors":"Chunling Xue, Jingxia Zeng, Wenjing Li","doi":"10.1186/s12873-024-01091-x","DOIUrl":"10.1186/s12873-024-01091-x","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective study aimed to analyze the clinical characteristics and toxicological spectrum of acute poisoning in children treated at our pediatric intensive care unit. The findings provide a basis for the treatment and prevention of acute poisoning in children.</p><p><strong>Methods: </strong>Clinical data of hospitalized children aged 0 to14 years with acute poisoning, treated between January 2015 and December 2023, were collected and analyzed. The analysis included the types of poisoning, sex and age distribution of children, routes and causes of poisoning, time from poisoning to medical consultation, length of hospital stays, and treatment outcomes.</p><p><strong>Results: </strong>Among the 493 cases of acute poisoning in children, pesticide poisoning (n = 252, 51.1%) was the most common type, followed by medication poisoning (n = 182, 36.9%). Chemical poisoning accounted for 7.7% (n = 38), while food poisoning and inhalation of harmful gases accounted for 3.0% (n = 15) and 1.2% (n = 6), respectively. The main route of poisoning was oral ingestion (n = 477, 96.8%), while accidental ingestion accounted for a large proportion (n = 379, 79.4%), and adolescents aged 11 to 14 years accounted for 20.6% (n = 98).Apart from the predominance of girls attempting suicide by self-administering antipsychotic medications (n = 88, 75.9%) due to depression, there was no significant difference in sex distribution among other types of poisoning children. The highest incidence of poisoning except children who self-administer antipsychotic drugs occurred in children aged 1-3 years (n = 267, 54.2%) and 8-14 years (n = 135, 27.4%), with the highest proportion in the preschool age group. The average time from poisoning to medical consultation was 33.4 ± 54.9 h, and majority of children received treatment within 48 h after poisoning (n = 423, 85.8%). The overall effective treatment rate was 96.8%.</p><p><strong>Conclusion: </strong>Acute poisoning in children has complex and diverse causes, with accidental ingestion being the main route. Prevention should be emphasized, including strengthening child safety education and improving parental supervision. Moreover, psychological health education is crucial for adolescents during their puberty. In the event of acute poisoning, prompt medical consultation and appropriate treatment are necessary to mitigate adverse outcomes.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"181"},"PeriodicalIF":2.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The performance of screening tools and use of blood analyses in prehospital identification of sepsis patients and patients suitable for non-conveyance - an observational study.","authors":"Agnes Olander, Lina Frick, Jennifer Johansson, Kristoffer Wibring","doi":"10.1186/s12873-024-01098-4","DOIUrl":"10.1186/s12873-024-01098-4","url":null,"abstract":"<p><strong>Background: </strong>Early recognition of sepsis by the EMS (Emergency Medical Services), along with communicating this concern to the emergency department, could improve patient prognosis and outcome. Knowledge is limited about the performance of sepsis identification screening tools in the EMS setting. Research is also limited on the effectiveness of prehospital use of blood tests for sepsis identification. Integrating blood analyses with screening tools could improve sepsis identification, leading to prompt interventions and improved patient outcomes.</p><p><strong>Aim: </strong>The aim of the present study is firstly to evaluate the performance of various screening tools for sepsis identification in the EMS setting and secondly to assess the potential improvement in accuracy by incorporating blood analyses.</p><p><strong>Methods: </strong>This is a retrospective observational cohort study. The data were collected from prehospital and hospital medical records in Region Halland. Data on demographics, vital signs, blood tests, treatment, and outcomes were collected from patients suspected by EMS personnel of having infection. The data were analysed using Student's t-test. Sensitivity, specificity, positive predictive value, negative predictive value and odds ratio were used to indicate accuracy and predictive value.</p><p><strong>Results: </strong>In total, 5,405 EMS missions concerning 3,225 unique patients were included. The incidence of sepsis was 9.8%. None of the eleven tools included had both high sensitivity and specificity for sepsis identification. White blood cell (WBC) count was the blood analysis with the highest sensitivity but the lowest specificity for identifying sepsis. Adding WBC, C-reactive protein (CRP) or lactate to the National Early Warning Score (NEWS) increased the specificity to > 80% but substantially lowered the sensitivity.</p><p><strong>Conclusions: </strong>Identifying sepsis in EMS settings remains challenging, with existing screening tools offering limited accuracy. CRP, WBC, and lactate blood tests add minimal predictive value in distinguishing sepsis or determining non-conveyance eligibility.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"24 1","pages":"180"},"PeriodicalIF":2.3,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}