Pre-hospital use of early warning scores to improve detection and outcomes of sepsis
Sepsis is a life-threatening complication from infection. The early detection of sepsis pre-hospital is challenging. Early warning scores (EWS) are used in hospitals to identify deteriorating patients. The pre-hospital setting could be a beneficial extension to the use of EWSs. This review aimed to determine whether EWSs can identify patients with sepsis pre-hospital and predict patient outcomes. Bibliographic databases were searched for studies evaluating the pre-hospital use of EWSs. Studies were screened using eligibility criteria. Two studies examined the ability of pre-hospital EWSs to identify patients with critical illness, showing high sensitivity but low specificity. Four studies determined the prognostic effects of the National Early Warning Score (NEWS). The patients identified by NEWS to be high-risk were associated with worse outcomes. This systematic review demonstrated the successful use of EWSs in the pre-hospital setting, in identifying patients most at risk of deterioration and as a useful tool for decision-making.
Sepsis is a major healthcare concern (Adhikari et al, 2010), resulting in an estimated 30 million cases globally each year and around 6 million deaths annually related to sepsis (Fleischmann et al, 2016). According to the UK Sepsis Trust (2019), there are at least 250 000 cases of sepsis and 52 000 sepsis-related deaths in the UK every year. One in four patients with sepsis die during hospitalisation, and sepsis survivors frequently experience long-term functional and cognitive impairment, resulting in significant social and economic impacts (Iwashyna et al, 2010; Mostel et al, 2020).
Acute changes in physiological parameters (respiratory rate, heart rate, oxygen saturations, blood pressure, temperature and level of consciousness) can be warning signs of deterioration in a patient. Early warning scores (EWSs) were developed to identify patients at risk of deterioration. The National Early Warning Score (NEWS) is an EWS developed by the Royal College of Physicians (RCP) for use in acute hospital settings, with the aim of standardising EWS use. It was initially introduced into the NHS in 2012, although there were systems of routine monitoring of patients being used prior to this as well (RCP, 2017).
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