Two out of the four internationally recommended screening tools used by emergency medical services (EMS) are inadequate for recognizing sepsis, say German researchers.
They say that new guidelines, which are being drawn up for sepsis screening, should be more precise and omit recommendations for two of the tools.
Scientists from the Campus Benjamin Franklin (CBF) Charité, Universitätsmedizin Berlin, and the universities of Magdeburg and Jena, presented findings from a study at the European Emergency Medicine Congress in Barcelona on Wednesday, September 20.
Sepsis, often referred to as blood poisoning, arises when the body’s immune system goes into overdrive in response to an infection and injures the body’s tissues and organs. It is vital to recognize it early, or it can lead to shock, multiple organ failure, and even death.
Silke Piedmont, a health scientist at the CBF Department of Emergency Medicine, and colleagues sought to assess which of four screening tools was best for EMS to predict sepsis.
The tools were NEWS-2 (National Early Warning Score), MEWS (Modified Early Warning Score), SIRS (Systemic Inflammatory Response Syndrome), and qSOFA (quick Sequential Organ Failure Assessment). The researchers analyzed data on 221,429 patients who were seen by EMS in Germany in 2016 outside of the hospital setting.
They linked the data with follow-up conducted between 2016 and 2017 from 10 health insurance companies with documentation from paramedics and emergency doctors on 110,419 cases in 2016. This follow-up enabled calculations of the four screening tools’ ability to predict that a patient had sepsis.
The predictions were confirmed or rejected during subsequent hospital investigations after contact with EMS. The researchers also looked at incidence and death rates for sepsis compared to heart attack and stroke, how much was recorded about any suspicions of sepsis, and how often EMS staff documented sepsis if they used screening tools.
Only one tool, NEWS-2, had a “reasonably accurate” prediction rate for sepsis. It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic cases. A second screening tool, qSOFA, correctly predicted 96.6% of patients who did not have sepsis. Out of all EMS cases, 24.3% of cases were predicted to have sepsis by at least one of the screening tools, but only 0.9% were predicted to have sepsis by all four tools simultaneously.
“We found that paramedics never documented a suspicion of sepsis, and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases,” Piedmont said.
The study showed that there was a similar incidence for sepsis (1.6%) as for heart attacks (2.6%) and stroke (2.7%) in cases seen by EMS. But deaths from sepsis were higher, with 31.4% of patients with sepsis dying within 30 days compared with 13.4% and 11.8% respectively for heart attacks and stroke.
“As most sepsis cases start outside of hospital, emergency medical services play a vital role. They can shorten the length of time until sepsis treatments can be provided quickly in hospitals and reduce the risk of dying if they suspect sepsis,” Piedmont said.
The picture would improve with better and more complete assessments of vital signs, such as body temperature and breathing rate, and “translating” alarming vital signs into a suspicion of sepsis, which could be helped by using a good sepsis screening tool.
The researchers say future sepsis guidelines should be more precise and omit recommendations for MEWS and SIRS for emergency medical services since they were “inferior in all the measures for accuracy.”