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Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study
- Agnes Olander, Carl Magnusson, Annelie J. Sundler, Anders Bremer, Henrik Andersson, Johan Herlitz, Christer Axelsson, Magnus Andersson Hagiwara
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 08 February 2023, pp. 160-167
- Print publication:
- April 2023
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Introduction:
The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting.
Study Objective:The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS.
Methods:A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used.
Results:A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS.
Conclusions:As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.
Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke
- Elin Andersson, Linda Bohlin, Johan Herlitz, Annelie J. Sundler, Zoltán Fekete, Magnus Andersson Hagiwara
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- Journal:
- Prehospital and Disaster Medicine / Volume 33 / Issue 1 / February 2018
- Published online by Cambridge University Press:
- 10 January 2018, pp. 63-70
- Print publication:
- February 2018
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Introduction
the early phase of stroke, minutes are critical. Since the majority of patients with stroke are transported by the Emergency Medical Service (EMS), the early handling and decision making by the EMS clinician is important.
ProblemThe study aim was to evaluate the frequency of a documented suspicion of stroke by the EMS nurse, and to investigate differences in the clinical signs of stroke and clinical assessment in the prehospital setting among patients with regard to if there was a documented suspicion of stroke on EMS arrival or not, in patients with a final hospital diagnosis of stroke.
MethodsThe study had a retrospective observational design. Data were collected from reports on patients who were transported by the EMS and had a final diagnosis of stroke at a single hospital in western Sweden (630 beds) in 2015. The data sources were hospital and prehospital medical journals.
ResultsIn total, 454 patients were included. Among them, the EMS clinician suspected stroke in 52%. The findings and documentation on patients with a suspected stroke differed from the remaining patients as follows:
a) More frequently documented symptoms from the face, legs/arms, and speech;
b) More frequently assessments of neurology, face, arms/legs, speech, and eyes;
c) More frequently addressed the major complaint with regard to time and place of onset, duration, localization, and radiation;
d) Less frequently documented symptoms of headache, vertigo, and nausea; and
e) More frequently had an electrocardiogram (ECG) recorded and plasma glucose sampled.
In addition to the 52% of patients who had a documented initial suspicion of stroke, seven percent of the patients had an initial suspicion of transitory ischemic attack (TIA) by the EMS clinician, and a neurologist was approached in another 10%.
ConclusionAmong 454 patients with a final diagnosis of stroke who were transported by the EMS, an initial suspicion of stroke was not documented in one-half of the cases. These patients differed from those in whom a suspicion of stroke was documented in terms of limited clinical signs of stroke, a less extensive clinical assessment, and fewer clinical investigations.
,Andersson E ,Bohlin L ,Herlitz J ,Sundler AJ ,Fekete Z .Andersson Hagiwara M Prehospital Identification of Patients with a Final Hospital Diagnosis of Stroke . Prehosp Disaster Med.2018 ;33 (1 ):63 –70 .