The PRESEP score: an early warning scoring system to identify septic patients in the emergency care setting
© Bayer et al.; licensee BioMed Central Ltd. 2014
Published: 3 December 2014
Many patients present with sepsis through emergency services . Their outcome could be improved if sepsis could be detected already in the prehospital setting. This study aims to develop and evaluate a score to detect prehospital early sepsis.
A retrospective study of 375 patients admitted to Jena University Hospital emergency department (ED) through emergency medical services (EMS). Sepsis was present in the ED in 93 (24.8%) patients, of which 60 (16.0%) had severe sepsis and 12 (3.2%) had septic shock. The following predictors for sepsis based on consensus criteria were extracted from the EMS protocol: body temperature (T), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), Glasgow Coma Scale, blood glucose and systolic blood pressure (BP). Sepsis predictors were determined based on inspection of loess graphs. Backward model selection was performed to select risk factors for the final model. The PRESEP score was calculated as the sum of simplified regression weights. Its predictive validity was compared to the modified Early Warning Score (MEWS) , the Robson screening tool  and the BAS 90-30-90 .
Backward model selection identified T, HR, RR, SaO2 and BP for inclusion in the PRESEP score. Its AUC was 0.93 (CI 0.89 to 0.96). The cutoff based on maximum Youden's Index was ≥4 (sensitivity 0.85, specificity 0.86, PPV 0.66, NPV 0.95). The PRESEP score had a larger AUC than the MEWS (0.93 vs. 0.77, P < 0.001) and surpassed MEWS and BAS 90-60-90 concerning sensitivity (0.74, 0.62), specificity (0.75, 0.83), PPV (0.45, 0.51) and NPV (0.91, 0.89). The Robson screening tool had a higher sensitivity and NPV (0.95, 0.97) was better, but its specificity and PPV lower (0.43, 0.43).
The PRESEP score can be easily applied in the emergency setting and could be a valuable tool to identify septic patients in the case of suspected infection.
OB was supported, in part, by an unrestricted grant of the Thuringian Ministry of Cultural Affairs (Landesprogramm ProExzellenz; PE 108-2), the Foundation of Technology, Innovation, and Research Thuringia (STIFT), and the German Sepsis Society. JKR and CSH receive CSCC research grants. DS is funded in full by the Center for Sepsis Control and Care (CSCC). The CSCC is funded by the German Federal Ministry of Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1002.
- Seymour CW, Rea TD, Kahn JM, Walkey AJ, Yealy DM, Angus DC: Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med 2012, 186: 1264-1271. 10.1164/rccm.201204-0713OCView ArticlePubMedPubMed CentralGoogle Scholar
- Subbe CP, Kruger M, Rutherford P, Gemmel L: Validation of a modified Early Warning Score in medical admissions. QJM 2001, 94: 521-526. 10.1093/qjmed/94.10.521View ArticlePubMedGoogle Scholar
- Robson W, Nutbeam T, Daniels R: Sepsis: a need for prehospital intervention? Emerg Med J 2009, 26: 535-538. 10.1136/emj.2008.064469View ArticlePubMedGoogle Scholar
- Ljungstrom L: A challenge to doctors of infectious disease: make the management of patients with acute severe bacterial infection as good as the management of acute coronary syndromes.[http://www.mediahuset.se/Infektionslakaren/il405/en_utmaning.htm]
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.