TY - JOUR
T1 - Characteristics of the prehospital phase of adult emergency department patients with an infection
T2 - A prospective pilot study
AU - Latten, Gideon H. P.
AU - Claassen, Lieke
AU - Jonk, Marnix
AU - Cals, Jochen W. L.
AU - Muris, Jean W. M.
AU - Stassen, Patricia M.
N1 - Publisher Copyright:
© 2019 Latten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/2/7
Y1 - 2019/2/7
N2 - ObjectiveResearch on serious infections/sepsis has focused on the hospital environment, while potentially the most delay, and therefore possibly the best opportunity to improve quality of care, lies in the prehospital setting. In this study we investigated the prehospital phase of adult emergency department (ED) patients with an infection.MethodsIn this prospective pilot study all adult (>= 18y) patients with a suspected/proven infection, based on the notes in the patient's ED chart, were included during a 4-week period in 2017. Prehospital course, ED findings, presence of sepsis and 30-day outcomes were registered.ResultsA total of 440 patients were identified, with a median symptom duration before ED visit of 3 days (IQR 1-7 days). Before arrival in the ED, 23.9% of patients had used antibiotics. Most patients (83.0%) had been referred by a general practitioner (GP), while 41.1% of patients had visited their GP previously during the current disease episode. Patients referred by a GP were triaged as high-urgency less often, while vital parameters were similar. Emergency Medical Services (EMS) transported 268 (60.9%) of patients. Twenty-two patients (5.0%) experienced an adverse outcome (30-day all-cause mortality and/or admission to intensive care).ConclusionsPatients with a suspected infection had symptoms for 3 (IQR 1-7) days at the moment of presentation to the ED. During this prehospital phase patients often had consulted, and were treated by, their GP. Many were transported to the ED by EMS. Future research on severe infections should focus on the prehospital phase, targeting patients and primary care professionals.
AB - ObjectiveResearch on serious infections/sepsis has focused on the hospital environment, while potentially the most delay, and therefore possibly the best opportunity to improve quality of care, lies in the prehospital setting. In this study we investigated the prehospital phase of adult emergency department (ED) patients with an infection.MethodsIn this prospective pilot study all adult (>= 18y) patients with a suspected/proven infection, based on the notes in the patient's ED chart, were included during a 4-week period in 2017. Prehospital course, ED findings, presence of sepsis and 30-day outcomes were registered.ResultsA total of 440 patients were identified, with a median symptom duration before ED visit of 3 days (IQR 1-7 days). Before arrival in the ED, 23.9% of patients had used antibiotics. Most patients (83.0%) had been referred by a general practitioner (GP), while 41.1% of patients had visited their GP previously during the current disease episode. Patients referred by a GP were triaged as high-urgency less often, while vital parameters were similar. Emergency Medical Services (EMS) transported 268 (60.9%) of patients. Twenty-two patients (5.0%) experienced an adverse outcome (30-day all-cause mortality and/or admission to intensive care).ConclusionsPatients with a suspected infection had symptoms for 3 (IQR 1-7) days at the moment of presentation to the ED. During this prehospital phase patients often had consulted, and were treated by, their GP. Many were transported to the ED by EMS. Future research on severe infections should focus on the prehospital phase, targeting patients and primary care professionals.
KW - SEPTIC SHOCK
KW - SEPSIS
KW - EPIDEMIOLOGY
KW - DEFINITIONS
KW - MORTALITY
U2 - 10.1371/journal.pone.0212181
DO - 10.1371/journal.pone.0212181
M3 - Article
C2 - 30730990
SN - 1932-6203
VL - 14
JO - PLOS ONE
JF - PLOS ONE
IS - 2
M1 - 0212181
ER -