A prehospital screening tool utilizing end-tidal carbon dioxide predicts sepsis and severe sepsis

The American Journal of Emergency Medicine
Christopher L HunterLinda Papa

Abstract

To determine the utility of a prehospital sepsis screening protocol utilizing systemic inflammatory response syndrome (SIRS) criteria and end-tidal carbon dioxide (ETCO2). We conducted a prospective cohort study among sepsis alerts activated by emergency medical services during a 12 month period after the initiation of a new sepsis screening protocol utilizing ≥2 SIRS criteria and ETCO2 levels of ≤25 mmHg in patients with suspected infection. The outcomes of those that met all criteria of the protocol were compared to those that did not. The main outcome was the diagnosis of sepsis and severe sepsis. Secondary outcomes included mortality and in-hospital lactate levels. Of 330 sepsis alerts activated, 183 met all protocol criteria and 147 did not. Sepsis alerts that followed the protocol were more frequently diagnosed with sepsis (78% vs 43%, P < .001) and severe sepsis (47% vs 7%, P < .001), and had a higher mortality (11% vs 5%, P = .036). Low ETCO2 levels were the strongest predictor of sepsis (area under the ROC curve (AUC) of 0.99, 95% CI 0.99-1.00; P < .001), severe sepsis (AUC 0.80, 95% CI 0.73-0.86; P < .001), and mortality (AUC 0.70, 95% CI 0.57-0.83; P = .005) among all prehospital variables. Sepsis alerts that followe...Continue Reading

References

Jan 1, 1992·Critical Care Medicine·B A Mizock, J L Falk
Jan 17, 2002·The New England Journal of Medicine·E RiversUNKNOWN Early Goal-Directed Therapy Collaborative Group
Dec 4, 2002·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Deirdre M Fearon, Dale W Steele
Jul 31, 2004·The Journal of Trauma·Charles D DeakinGareth Davies
Apr 28, 2005·Annals of Emergency Medicine·Nathan I ShapiroJ Woodrow Weiss
Apr 18, 2008·Internal and Emergency Medicine·Daniel C McGillicuddyNathan I Shapiro
Dec 19, 2008·Critical Care : the Official Journal of the Critical Care Forum·Tim C JansenJan Bakker
Dec 17, 2009·Resuscitation·Henry E WangDonald M Yealy
Mar 5, 2010·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Christopher W SeymourRoger A Band
Apr 13, 2010·Journal of Critical Care·Christopher W SeymourDavid F Gaieski
Sep 10, 2010·The American Journal of Emergency Medicine·Mutlu KartalCenker Eken
Oct 30, 2010·The American Journal of Emergency Medicine·Jonathan R StudnekAlan E Jones
Jul 26, 2012·International Journal of Emergency Medicine·Cheah P Kheng, Nik H Rahman
Aug 8, 2012·The American Journal of Emergency Medicine·Christopher L HunterLinda Papa
Dec 18, 2013·The American Journal of Emergency Medicine·Christopher L HunterLinda Papa
Mar 19, 2014·The New England Journal of Medicine·Donald M YealyDerek C Angus
Sep 28, 2014·Critical Care : the Official Journal of the Critical Care Forum·Christopher W SeymourDerek C Angus

❮ Previous
Next ❯

Citations

Nov 16, 2018·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Holly E DepinetLynn Babcock
Jul 18, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Michael A SmythGavin D Perkins
Apr 16, 2020·Prehospital and Disaster Medicine·Christopher HunterLinda Papa
Oct 11, 2017·The Journal of Emergency Medicine·Brit LongMichael A Vivirito
Apr 19, 2020·The American Journal of Emergency Medicine·Jin Hee KimSang-Min Lee
Jul 24, 2021·Journal of the American College of Emergency Physicians Open·Mitchell BarneckJosef Thundiyil

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.