Usefulness of sepsis screening tools and education in recognising the burden of sepsis on hospital wards

Abstract Objective The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-h bundle was also evaluated. Design Interrupted times series with prospective data collection. Setting Five hospital wards in a developing nation, Argentina. Participants A total of 1151 patients (≥18 years) recruited within 24–48 h of hospital admission. Intervention The qSOFA-based SS tool and the 6-h bundle. Main outcome measures The primary outcome was the timing of implementation of the first 6-h bundle element. Secondary outcomes were related to the adherence to the screening procedures. Results Of 1151 patients, 145 (12.6%) met the qSOFA-based SS tool criteria, among them intervention (39/64) patients received the first 6-h bundle element earlier (median 8 h; 95% confidence interval (CI): 0.1–16) than baseline (48/81) patients (median 22 h; 95% CI: 3–41); these times, however, did not differ significantly (P = 0.525). Overall, 47 (4.1%) patients had sepsis; intervention patients (18/25) received the first 6-h bundle element sooner (median 5 h; 95% CI: 4–6) than baseline patients (15/22) did (median 12 h; 95% CI: 0–33); however, times were not significantly different (P = 0.470). While intervention patients were screened regularly, only one-third of patients who required sepsis alerts had them activated. Conclusion The implementation of the qSOFA-based SS tool resulted in early, but not significantly improved, provision of 6-h bundle care. Screening procedures were regularly conducted, but sepsis alerts rarely activated. Further research is needed to better understand the implementation of sepsis care in developing settings.

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Sepsis Screening Tools

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v1i3.72 ◽

2013 ◽

Vol 1 (3) ◽

pp. 12

Author(s):

Amanda Venable

Keyword(s):

Screening Tools ◽

Sepsis Screening

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Sepsis Screening Tools in the Era of Sepsis 3.0

Surgical Infections ◽

10.1089/sur.2018.039 ◽

2018 ◽

Vol 19 (5) ◽

pp. 553-553 ◽

Cited By ~ 1

Author(s):

Xianshi Zhou ◽

Ye Ye ◽

Guanghua Tang

Keyword(s):

Screening Tools ◽

Sepsis Screening

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Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection: a prospective cohort study

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00958-3 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Ulrika M. Wallgren ◽

Jan Sjölin ◽

Hans Järnbert-Pettersson ◽

Lisa Kurland

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Clinical Judgment ◽

Prospective Cohort ◽

Screening Tools ◽

Early Warning Score ◽

Receiver Operating Curve ◽

Suspected Infection ◽

Significant Difference ◽

Sepsis Screening

Abstract Background There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment. Methods Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong’s test. Results The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87–0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39–0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75–0.77) was similar. Conclusions The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation. Trial registration: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597.

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Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

Journal of Clinical Medicine ◽

10.3390/jcm8091337 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1337 ◽

Cited By ~ 5

Author(s):

Maja Kopczynska ◽

Ben Sharif ◽

Harry Unwin ◽

John Lynch ◽

Andrew Forrester ◽

...

Keyword(s):

Healthcare Providers ◽

Significant Proportion ◽

Secondary Analysis ◽

Real Life ◽

Point Prevalence ◽

Screening Tools ◽

Antibiotic Administration ◽

Prevalence Studies ◽

Acute Hospitals ◽

Sepsis Screening

Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.

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Point-of-care lactate measurement for suspected sepsis in the prehospital environment: are we missing the point at the sharp end?

British Journal of Healthcare Management ◽

10.12968/bjhc.2019.0071 ◽

2020 ◽

Vol 26 (4) ◽

pp. 1-9

Author(s):

Bryan Lightowler

Keyword(s):

Point Of Care ◽

Vital Signs ◽

Screening Tools ◽

Handheld Devices ◽

Services Research ◽

Suspected Sepsis ◽

Lactate Measurement ◽

Life Threatening ◽

Lactate Levels ◽

Sepsis Screening

Expecting ambulance clinicians to dependably differentiate the life-threatening organ dysfunction caused by sepsis from an inflammatory response to a non-infectious aetiology, relying upon vital signs and a physical examination of the patient alone, must be considered unrealistic. Although lactate measurement has been integrated into numerous prehospital sepsis screening tools, it is not yet measured routinely within UK ambulance services. Research has generally focused on whether handheld point-of-care lactate measurement devices are as accurate as laboratory analysis of venous or arterial samples. The weight of literature has concluded negatively in relation to this. However, there is potential for handheld devices to be used independently to monitor trends in lactate elimination or accumulation to inform decisions on the efficacy of prehospital interventions, or simply to report categorical data in terms of whether lactate levels are elevated or not. This offers UK paramedics the opportunity to improve sepsis care through the enhanced assessment of risk and acuity, the identification of patients with cryptic shock, more aggressive fluid resuscitation and advanced notification to receiving units.

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