Prehospital early warning scores for sepsis

• Research type

  Research Study

• Full title

  Accuracy, impact and cost-effectiveness of prehospital clinical early warning scores for adults with suspected sepsis

• IRAS ID

  262367

• Contact name

  Steve Goodacre

• Contact email

  s.goodacre@sheffield.ac.uk

• Sponsor organisation

  Sheffield Teaching Hospitals NHS Foundation Trust

• Duration of Study in the UK

  1 years, 11 months, 30 days

• Research summary

  Summary of Research
  Sepsis is a life-threatening condition caused by the body having an abnormal response to infection that leads to heart, lung and kidney failure. People with sepsis need urgent treatment with antibiotics and intravenous fluids, and may need urgent intensive care treatment. However, features of sepsis may be seen with other illnesses. This can make it difficult to correctly identify who has sepsis and who has another diagnosis. Furthermore, treatments for sepsis may be futile or not in the patient’s best interests if the patient has severe medical problems or terminal illness. Unnecessary tests and treatments are distressing for patients and use valuable NHS resources.

  Early warning scores can be used to identify patients with sepsis who need urgent treatment. They use simple measurements such as blood pressure, heart rate and breathing rate to determine whether a patient is likely to have sepsis. An accurate early warning score could help paramedics, doctors and nurses ensure that people with sepsis are identified and treated quickly. However, an inaccurate early warning score might miss cases of sepsis or falsely identify people with other conditions.

  We are planning a study to test early warning scores for sepsis. We plan to collect data from a large group of people who are brought to hospital by ambulance and might have sepsis. We will determine whether they actually have sepsis and whether they needed urgent treatment. We will determine how accurately the early warning scores identified people with and without sepsis that needed urgent treatment. We will then use mathematical modelling to compare different early warning scores in terms of improving survival and effects on organisation of the emergency department and the costs of providing care. This will allow us to identify the best early warning score for the NHS.

  Summary of Results
  We found that none of the currently available early warning scores were ideal. When they were applied to all patients they prioritised too many people. When they were only applied to patients who the paramedics thought had infection they missed many cases of sepsis. The NEWS2 score, which ambulance services already use, was as good as or better than all the other scores we studied. We found that using the NEWS2 score in people with a paramedic impression of infection could achieve a reasonable balance between prioritising too many patients and avoiding missing patients with sepsis

• REC name

  London - Stanmore Research Ethics Committee

• REC reference

  19/LO/1443

• Date of REC Opinion

  24 Sep 2019

• REC opinion

  Favourable Opinion