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Prehospital intravenous access and fluid resuscitation in severe sepsis: An observational cohort study

Seymour, CW and Cooke, CR and Heckbert, SR and Spertus, JA and Callaway, CW and Martin-Gill, C and Yealy, DM and Rea, TD and Angus, DC (2014) Prehospital intravenous access and fluid resuscitation in severe sepsis: An observational cohort study. Critical Care, 18 (5). ISSN 1364-8535

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Abstract

© 2014 Seymour et al. Introduction: Prompt treatment of severe sepsis in the Emergency Department reduces deaths, but the role of prehospital fluid resuscitation is unknown. We sought to determine the risk-adjusted association between prehospital fluid administration and hospital mortality among emergency medical services (EMS) patients admitted with severe sepsis. Methods: We performed a prospective, observational study of patients hospitalized with severe sepsis on admission among 45,394 adult EMS encounters taken to 15 hospitals from 11/2009 to 12/2010 by a two-tier EMS system in King County, Washington. The region mandated recording of prehospital intravenous catheter and fluid administration in prehospital records, along with detailed demographic, incident, physiologic, and hospital adjustment variables. We determined the effect of prehospital intravenous catheter or fluid versus no catheter or fluid on all-cause mortality using multivariable logistic regression. Results: Of all encounters, 1,350 met criteria for severe sepsis on admission, of whom 205 (15%) died by hospital discharge, 312 (23%) received prehospital intravenous fluid, 90 (7%) received a prehospital catheter alone and 948 (70%) did not receive catheter or fluid. EMS administered a median prehospital fluid volume of 500 mL (interquartile range (IQR): 200, 1000 mL). In adjusted models, the administration of any prehospital fluid was associated with reduced hospital mortality (Odds ratio =0.46; 95% Confidence interval: 0.23, 0.88; P =0.02) compared to no prehospital fluid. The odds of hospital mortality were also lower among severe sepsis patients treated with prehospital intravenous catheter alone (Odds ratio =0.3; 95% Confidence interval: 0.17 to 0.57; P <0.01). Conclusions: In a population-based study, the administration of prehospital fluid and placement of intravenous access were associated with decreased odds of hospital mortality compared with no prehospital catheter or fluid.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Seymour, CWseymourc@pitt.eduSEYMOURC0000-0002-6257-6764
Cooke, CR
Heckbert, SR
Spertus, JA
Callaway, CWcallaway@pitt.eduCALLAWAY
Martin-Gill, Cchm36@pitt.eduCHM36
Yealy, DMdmy@pitt.eduDMY
Rea, TD
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Date: 1 January 2014
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 18
Number: 5
DOI or Unique Handle: 10.1186/s13054-014-0533-x
Schools and Programs: School of Medicine > Critical Care Medicine
School of Medicine > Emergency Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 19 Sep 2016 16:38
Last Modified: 06 Oct 2020 18:55
URI: http://d-scholarship.pitt.edu/id/eprint/29485

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