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Volume 18 Supplement 2

Sepsis 2014

The PRESEP score: an early warning scoring system to identify septic patients in the emergency care setting

Introduction

Many patients present with sepsis through emergency services [1]. 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.

Methods

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) [2], the Robson screening tool [3] and the BAS 90-30-90 [4].

Results

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).

Conclusion

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.

References

  1. 1.

    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.201204-0713OC

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    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/94.10.521

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Robson W, Nutbeam T, Daniels R: Sepsis: a need for prehospital intervention? Emerg Med J 2009, 26: 535-538. 10.1136/emj.2008.064469

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    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]

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Acknowledgements

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.

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Correspondence to O Bayer.

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Bayer, O., Hartog, C., Schwarzkopf, D. et al. The PRESEP score: an early warning scoring system to identify septic patients in the emergency care setting. Crit Care 18, P19 (2014). https://doi.org/10.1186/cc14022

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Keywords

  • Severe Sepsis
  • Early Warning
  • Glasgow Coma Scale
  • Septic Patient
  • Emergency Medical Service