PMID- 37071593
OWN - NLM
STAT- MEDLINE
DCOM- 20230802
LR  - 20230921
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 27
IP  - 6
DP  - 2023
TI  - Prehospital Fluid Administration for Suspected Sepsis in a Large EMS System: 
      Opportunities to Improve Goal Fluid Delivery.
PG  - 769-774
LID - 10.1080/10903127.2023.2203526 [doi]
AB  - OBJECTIVES: Despite EMS-implemented screening and treatment protocols for 
      suspected sepsis patients, prehospital fluid therapy is variable. We sought to 
      describe prehospital fluid administration in suspected sepsis patients, including 
      demographic and clinical factors associated with fluid outcomes. METHODS: A 
      retrospective cohort of adult patients from a large, county-wide EMS system from 
      January 2018-February 2020 was identified. Patient care reports for suspected 
      sepsis were included, as identified by EMS clinician impression of sepsis, or 
      keywords "sepsis" or "septic" in the narrative. Outcomes were the proportions of 
      suspected sepsis patients for whom intravenous (IV) therapy was attempted and 
      those who received >/=500 mL IV fluid if IV access was successful. Associations 
      between patient demographics and clinical factors with fluid outcomes were 
      estimated with multivariable logistic regression adjusting for transport 
      interval. RESULTS: Of 4,082 suspected sepsis patients identified, the mean 
      patient age was 72.5 (SD 16.2) years, 50.6% were female, and 23.8% were Black. 
      Median (interquartile range [IQR]) transport interval was 16.5 (10.9-23.2) 
      minutes. Of identified patients, 1,920 (47.0%) had IV fluid therapy attempted, 
      and IV access was successful in 1,872 (45.9%). Of those with IV access, 1,061 
      (56.7%) received >/=500mL of fluid from EMS. In adjusted analyses, female (versus 
      male) sex (odds ratio [OR] 0.79, 95% confidence interval [CI] 0.69-0.90), Black 
      (versus White) race (OR 0.57, 95% CI 0.49-0.68), and end stage renal disease (OR 
      0.51, 95% CI 0.32-0.82) were negatively associated with attempted IV therapy. 
      Systolic blood pressure (SBP) <90 mmHg (OR 3.89, 95% CI 3.25-4.65) and 
      respiratory rate >20 (OR 1.90, 95% CI 1.61-2.23) were positively associated with 
      attempted IV therapy. Female sex (OR 0.72, 95% CI 0.59-0.88) and congestive heart 
      failure (CHF) (OR 0.55, 95% CI 0.40-0.75) were negatively associated with 
      receiving goal fluid volume while SBP <90 mmHg (OR 2.30, 95% CI 1.83-2.88) and 
      abnormal temperature (>100.4 F or <96 F) (OR 1.41, 95% CI 1.16-1.73) were 
      positively associated. CONCLUSIONS: Fewer than half of EMS sepsis patients had IV 
      therapy attempted, and of those, approximately half met fluid volume goal, 
      especially when hypotensive and no CHF. Further studies are needed on improving 
      EMS sepsis training and prehospital fluid delivery.
FAU - Miller, Nathaniel S
AU  - Miller NS
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
FAU - Patel, Mehul D
AU  - Patel MD
AUID- ORCID: 0000-0002-1281-3207
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
FAU - Williams, Jefferson G
AU  - Williams JG
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
AD  - Wake County EMS, Raleigh, North Carolina.
FAU - Bachman, Michael W
AU  - Bachman MW
AD  - Wake County EMS, Raleigh, North Carolina.
FAU - Cyr, Julianne M
AU  - Cyr JM
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
FAU - Cabanas, Jose G
AU  - Cabanas JG
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
AD  - Wake County EMS, Raleigh, North Carolina.
FAU - Brice, Jane H
AU  - Brice JH
AD  - Department of Emergency Medicine, University of North Carolina School of 
      Medicine, Chapel Hill, North Carolina.
LA  - eng
PT  - Journal Article
DEP - 20230427
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
SB  - IM
CIN - Prehosp Emerg Care. 2023;27(6):767-768. PMID: 37307225
MH  - Adult
MH  - Humans
MH  - Male
MH  - Female
MH  - Aged
MH  - *Emergency Medical Services/methods
MH  - Retrospective Studies
MH  - Goals
MH  - *Sepsis/diagnosis/therapy
MH  - Fluid Therapy/methods
EDAT- 2023/04/19 06:00
MHDA- 2023/08/02 06:42
CRDT- 2023/04/18 13:13
PHST- 2023/08/02 06:42 [medline]
PHST- 2023/04/19 06:00 [pubmed]
PHST- 2023/04/18 13:13 [entrez]
AID - 10.1080/10903127.2023.2203526 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2023;27(6):769-774. doi: 10.1080/10903127.2023.2203526. Epub 
      2023 Apr 27.