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Am J Emerg Med. 2018 Dec;36(12):2211-2218. doi: 10.1016/j.ajem.2018.04.004. Epub 2018 Apr 5.

The early chain of care in bacteraemia patients: Early suspicion, treatment and survival in prehospital emergency care.

Author information

1
University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden. Electronic address: henrik.andersson@hb.se.
2
University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
3
Ambulance Department, South Älvsborg's Hospital, Borås, Sweden.
4
University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden.
5
University West, School of Business, Economy and IT, Trollhättan, Sweden.
6
University of Borås, PreHospen - Centre for Prehospital Researc Borås, Sweden; University of Gothenburg, The Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden.
7
Skaraborg Hospital, Infection Disease Department, Skövde, Sweden.

Abstract

INTRODUCTION:

Bacteraemia is a first stage for patients risking conditions such as septic shock. The primary aim of this study is to describe factors in the early chain of care in bacteraemia, factors associated with increased chance of survival during the subsequent 28days after admission to hospital. Furthermore, the long-term outcome was assessed.

METHODS:

This study has a quantitative design based on data from Emergency Medical Services (EMS) and hospital records.

RESULTS:

In all, 961 patients were included in the study. Of these patients, 13.5% died during the first 28days. The EMS was more frequently used by non-survivors. Among patients who used the EMS, the suspicion of sepsis already on scene was more frequent in survivors. Similarly, EMS personnel noted the ESS code "fever, infection" more frequently for survivors upon arriving on scene. The delay time from call to the EMS and admission to hospital until start of antibiotics was similar in survivors and non-survivors. The five-year mortality rate was 50.8%. Five-year mortality was 62.6% among those who used the EMS and 29.5% among those who did not (p<0.0001).

CONCLUSION:

This study shows that among patients with bacteraemia who used the EMS, an early suspicion of sepsis or fever/infection was associated with improved early survival whereas the delay time from call to the EMS and admission to hospital until start of treatment with antibiotics was not. 50.8% of all patients were dead after five years.

KEYWORDS:

Bacteraemia; Emergency Medical Services; Emergency care; Infection; Prehospital emergency care; Sepsis

PMID:
29653787
DOI:
10.1016/j.ajem.2018.04.004

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