Field Paramedic Application of Sepsis Triage

Study Overview
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Brief Summary
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Given the implementation of the Hamilton Early Warning Score (HEWS) and the use of capnography by paramedics, this study will involve a large multi-site retrospective evaluation (before vs after implementation) of the HEWS score and comparison of the HEWS to systemic inflammatory response syndrome (SIRS), quick Sepsis Related Organ failure Assessment (qSOFA) and Modified Early Warning Score (MEWS) when applied retrospectively for the identification of sepsis in the prehospital setting.

Detailed Description
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To determine the accuracy of the HEWS score, compared to qSOFA, and SIRS for early sepsis recognition when used in the prehospital setting by paramedics for the identification of patients with sepsis or suspected sepsis. To evaluate the addition of ETCO2 values to predict mortality in patients who screen positive for sepsis. To identify the before and after healthcare outcomes of a prehospital sepsis alert program.

Official Title
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Field Paramedic Application of Sepsis Triage

Conditions
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Sepsis

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any patient to which paramedics apply the Hamilton Early Warning Score or patients who arrive to the Emergency Department (ED) by ambulance without a pre-alert and meet the definition of sepsis in the ED will also be included, and patient is ≥ 18 years Exclusion Criteria: Patient is an inter-facility transfer, or patients with absent vital signs are absent, or death before blood can be drawn in the Emergency Department, or the patient fits the criteria for another prehospital alert (ST-elevation myocardial infarction, cerebrovascular vascular accident, or trauma)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Retrospective<br>The Investigators will examine data from 1-year prior to paramedic implementation of the Hamilton Early Warning Score tool. | |
| Prospective<br>The Investigators will examine data from 1-year after paramedic implementation of the Hamilton Early Warning Score tool. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy of HEWS | To determine the accuracy of the HEWS score, compared to qSOFA, and SIRS for early sepsis recognition when used in the prehospital setting by paramedics for the identification of patients with sepsis or suspected sepsis. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluate the addtion of end-tidal carbon dioxide (ETCO2) values | To evaluate the addition of ETCO2 values to predict mortality in patients who screen positive for sepsis. | 1 year | 
| Evaluate sepsis alert program | To identify the before and after healthcare outcomes of a prehospital sepsis alert program. | 2 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sepsis, septic shock, early warning scores, infecion