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Emergency Medicine International
Volume 2016, Article ID 6717261, 5 pages
Research Article

Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study

1Department of Critical Care, Dalhousie University, Suite 377, Bethune Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9
2Trauma Nova Scotia, Room 1-026B, Centennial Building, 1276 South Park Street, Halifax, NS, Canada B3H 2Y9
3Department of Emergency Medicine, Dalhousie University, Division of EMS, 1796 Summer Street, Halifax Infirmary, Suite 355, Halifax, NS, Canada B3H 3A7
4Emergency Health Service, 239 Brownlow Avenue, Suite 300, Dartmouth, NS, Canada B3B 2B2
5Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada B3H 4R2

Received 22 December 2015; Accepted 17 February 2016

Academic Editor: Rade B. Vukmir

Copyright © 2016 Robert S. Green et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Patients with sepsis benefit from early diagnosis and treatment. Accurate paramedic recognition of sepsis is important to initiate care promptly for patients who arrive by Emergency Medical Services. Methods. Prospective observational study of adult patients (age ≥ 16 years) transported by paramedics to the emergency department (ED) of a Canadian tertiary hospital. Paramedic identification of sepsis was assessed using a novel prehospital sepsis screening tool developed by the study team and compared to blind, independent documentation of ED diagnoses by attending emergency physicians (EPs). Specificity, sensitivity, accuracy, positive and negative predictive value, and likelihood ratios were calculated with 95% confidence intervals. Results. Overall, 629 patients were included in the analysis. Sepsis was identified by paramedics in 170 (27.0%) patients and by EPs in 71 (11.3%) patients. Sensitivity of paramedic sepsis identification compared to EP diagnosis was 73.2% (95% CI 61.4–83.0), while specificity was 78.8% (95% CI 75.2–82.2). The accuracy of paramedic identification of sepsis was 78.2% (492/629, 52 true positive, 440 true negative). Positive and negative predictive values were 30.6% (95% CI 23.8–38.1) and 95.9% (95% CI 93.6–97.5), respectively. Conclusion. Using a novel prehospital sepsis screening tool, paramedic recognition of sepsis had greater specificity than sensitivity with reasonable accuracy.