What’s New in the Patient Safety World
October 2015
Even Earlier Recognition of Severe Sepsis
Our September 8,
2015 Patient Safety Tip of the Week “TREWScore
for Early Recognition of Sepsis” discussed a new real-time early
warning score developed at Johns Hopkins (Henry 2015) to identify patients at risk for septic shock
and several similar tools to identify sepsis earlier.
But how about
identifying sepsis patients even before they reach the hospital! A new study
suggests that may be possible. Polito and
colleagues at Emory University (Polito
2015) derived and validated a predictive model and novel emergency medical services (EMS) screening
tool for severe sepsis. The PRESS score defined at-risk patients as having all
3 of the following criteria present in the EMS setting: (1) heart rate greater
than 90 beats/min, (2) respiratory rate greater than 20 beats/min, and (3)
systolic blood pressure less than 110 mm Hg. Six EMS characteristics were found
to be predictors of severe sepsis: older age, transport from nursing home,
Emergency Medical Dispatch (EMD) 9-1-1 chief concern category of “sick person”,
hot tactile temperature assessment, low systolic blood pressure, and low oxygen
saturation. Sensitivity of the final model was 91% in the derivation group and
78% in the validation group. At a predefined threshold of 2 or more points,
prehospital severe sepsis (PRESS) score sensitivity was 86% and specificity of
47%. The authors noted that additional validation is needed before this tool
can be recommended for widespread clinical use.
Though we agree that
the PRESS score needs to be validated at other sites before widespread
adoption, this is most encouraging. Identification of patients likely to have
sepsis before they even reach the ED should make early intervention much more
likely and improve patient outcomes. It’s even conceivable that someday the
early sepsis interventions might even begin while the patient is in transport
to the hospital.
Hopefully, tools
like the TREWScore and PRESS score will prove to be
valuable additions to our armamentarium of tools in our fight to reduce
morbidity and mortality from sepsis.
Some of our other columns dealing with sepsis, severe
sepsis, and septic shock:
- March 15, 2011 Patient
Safety Tip of the Week “Early
Warnings for Sepsis”
- October 18, 2011 “High-Risk Surgical Patients”
- February 2013 “More
Evidence Favoring Restriction of Transfusions”
- May 14, 2013 “Acute Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)”
- April 1, 2014 “Expensive
Aspects of Sepsis Protocol Debunked”
- January 2015 “Beneficial Effect of EMR on Patient Safety”
- September 8, 2015 “TREWScore
for Early Recognition of Sepsis”
References:
Henry KE, Hager DN, Pronovost PJ,
Saria S. A targeted real-time early warning score (TREWScore)
for septic shock. Science
Translational Medicine 2015; 299(7): 299ra122; 05 Aug 2015
http://stm.sciencemag.org/content/7/299/299ra122
Polito CC, Isakov A, Yancey AH, et al. Prehospital recognition of severe sepsis: development and validation of a novel EMS screening tool. Amer J Emerg Med 2015; 33(9): 1119–1125 Published online: April 22 2015
http://www.ajemjournal.com/article/S0735-6757%2815%2900272-7/abstract
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