2 results
P036: Sensitivity and false negatives in the use of a prehospital sepsis alert
- S. Sample, D. Quinlan, K. Willis, D. Casement, K. Lutz-Graul, M. Welsford
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S77
- Print publication:
- May 2020
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Introduction: Prehospital sepsis alerts assist paramedics in identifying patients with sepsis and in communicating this diagnosis to receiving facilities. Following the prospective implementation study of our regional systemic inflammatory response syndrome-based alert criteria (Alert), the purpose of this sub-study was to determine the cause of Alert false negatives (patients without an Alert that subsequently met sepsis criteria in the Emergency Department (ED)). Additionally, the sensitivity of the Alert for detecting sepsis was compared to the Quick Sequential Organ Failure Assessment (qSOFA) and Hamilton Early Warning Score (HEWS). Methods: This study was an additional analysis of the prospective Alert implementation study. Included patients were ≥ 18 years old, transported by a regional Emergency Medical Service and met severe sepsis or septic shock criteria (SS/SS, 2012 Surviving Sepsis Guidelines) in regional EDs in 2013. False negative patients were identified prospectively and reviewed by comparing paramedic determined Alert status to the retrospective application of the Alert criteria to Paramedic Call Report (PCR) data. The Alert sensitivity was first calculated from prospective data, then retrospective sensitivities of the Alert, qSOFA and HEWS were calculated by retrospectively applying these tools to PCRs, using ED diagnosis of SS/SS as reference standard. Results: In 2013, 229 patients met SS/SS criteria in the ED and had PCRs available; 115 (50.2%) were male and median age [interquartile range] was 76.0 [63.0-84.0]. Of 229, 149 (65.0%) arrived in the ED without an Alert (false negatives) and 46 (30.9%) of these met Alert criteria retrospectively and were therefore missed by paramedics. Sensitivity of the Alert was 34.9% when applied by paramedics and 41.5% when applied retrospectively to PCRs. The retrospective sensitivities of the qSOFA and HEWS were 37.6% and 67.7%, respectively. Conclusion: In ED patients diagnosed with SS/SS who arrived with no Alert, the majority (69.1%) were missed by the Alert criteria, rather than by paramedic application of the tool. The Alert had a sensitivity of 34.9%. When applied retrospectively and compared to the Alert, qSOFA had similar sensitivity and HEWS had increased sensitivity. Future research should focus on deriving improved alerts or implementing those with higher accuracy, such as HEWS.
P008: Care of palliative patients by paramedics in the 911 system
- C. Wallner, M. Welsford, K. Lutz-Graul, K. Winter
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S67
- Print publication:
- May 2020
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Introduction: Palliative Care aims to relieve suffering and improve the quality of living and dying in patients with life-limiting, progressive conditions. Many patients and families prefer to stay at home at end of life. Despite this, many access 911 in times of apparent crisis. It has been noted in the literature that a well functioning palliative care system includes considering Emergency Medical Services as part of the patients’ circle of care. Training in palliative care is traditionally limited or absent for prehospital clinicians, including Paramedics and Emergency Medical Services Physicians. Furthermore, in our region, there are currently no medical directives available to Paramedics within the 911 system specifically addressing the needs of palliative care patients. Methods: A feasibility study (Expanding Care by Paramedics for Palliative Patients – EC3P) was designed to evaluate implementation of a new palliative care medical directive with trained teams of Paramedics available to respond to 911 calls. As part of this study, a pre-implementation retrospective chart review was performed. Patient care records were screened for “palliative” within the past medical history and text fields. Information about dispatch and scene times, patient demographics, details of patient encounter, and disposition of the patient were recorded. Descriptive statics were used. Results: Data was reviewed for all calls in 2018. Call data was reviewed to exclude those that were pediatric (<18yo) and those whose palliative status was unknown or unclear. There was a total of 318 calls. The majority of the calls (83%) were between 7am and 8pm, with peaks at 10 am and 6pm. The majority were transported to hospital (74%), 16% were transferred to hospital initiated by their palliative care physician, 20% “refused” transport, and 6% were declared dead and not transported. The most common reasons for calling 911 were new symptoms or a sudden worsening of chronic symptoms, followed by needs exceeding caregiver capacity; the third most common was lift assist without apparent injury. Conclusion: Much is unknown about the palliative patient population as it intersects with prehospital emergency care. This study will help provide information needed to guide further research and implementation.