Skip to main content Accessibility help

The Prehospital Sepsis Project: Out-of-Hospital Physiologic Predictors of Sepsis Outcomes

  • Amado Alejandro Baez (a1), Priscilla Hanudel (a2) and Susan Renee Wilcox (a3)



Severe sepsis and septic shock are common, expensive and often fatal medical problems. The care of the critically sick and injured often begins in the prehospital setting; there is limited data available related to predictors and interventions specific to sepsis in the prehospital arena. The objective of this study was to assess the predictive effect of physiologic elements commonly reported in the out-of-hospital setting in the outcomes of patients transported with sepsis.


This was a cross-sectional descriptive study. Data from the years 2004-2006 were collected. Adult cases (≥18 years of age) transported by Emergency Medical Services to a major academic center with the diagnosis of sepsis as defined by ICD-9-CM diagnostic codes were included. Descriptive statistics and standard deviations were used to present group characteristics. Chi-square was used for statistical significance and odds ratio (OR) to assess strength of association. Statistical significance was set at the .05 level. Physiologic variables studied included mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and shock index (SI).


Sixty-three (63) patients were included. Outcome variables included a mean hospital length of stay (HLOS) of 13.75 days (SD = 9.97), mean ventilator days of 4.93 (SD = 7.87), in-hospital mortality of 22 out of 63 (34.9%), and mean intensive care unit length-of-stay (ICU-LOS) of 7.02 days (SD = 7.98). Although SI and RR were found to predict intensive care unit (ICU) admissions, [OR 5.96 (CI, 1.49-25.78; P = .003) and OR 4.81 (CI, 1.16-21.01; P = .0116), respectively] none of the studied variables were found to predict mortality (MAP <65 mmHg: P = .39; HR >90: P = .60; RR >20 P = .11; SI >0.7 P = .35).


This study demonstrated that the out-of-hospital shock index and respiratory rate have high predictability for ICU admission. Further studies should include the development of an out-of-hospital sepsis score.

BaezAA, HanudelP, WilcoxSR. The Prehospital Sepsis Project: Out-of-Hospital Physiologic Predictors of Sepsis Outcomes. Prehosp Disaster Med. 2013;28(6):1-4.


Corresponding author

Correspondence: Susan Renee Wilcox, MD Massachusetts General Hospital Department of Emergency Medicine Department of Anesthesia, Critical Care and Pain Medicine Zero Emerson Place, #3b Boston, MA 02114 USA E-mail


Hide All
1.Adrie, C, Alberti, C, Chaix-Couturier, C, et al. Epidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost. J Crit Care. 2005;20(1):46-58.
2.Dombrovskiy, VY, Martin, AA, Sunderram, J, Paz, HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244-1250.
3.Brun-Buisson, C, Doyon, F, Carlet, J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU group for severe sepsis. JAMA. 1995;274(12):968-974.
4.Dellinger, RP, Levy, MM, Carlet, JM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296-327.
5.Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis, for the ACCP/SCCM Consensus Conference Committee, American College of Chest Physicians/Society of critical care medicine. Chest. 1992;101(6):1644-1655.
6.Levy, MM, Fink, MP, Marshall, JC, et al. for ACCP/SCCM Consensus Conference Committee, 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31(4):1250-1256.
7.Anderson, RD, White, HD, Ohman, EM, et al. Predicting outcome after thrombolysis in acute myocardial infarction according to ST-segment resolution at 90 minutes: a substudy of the GUSTO-III trial. Global use of strategies to open occluded coronary arteries. Am Heart J. 2002;144(1):81-88.
8.Ali, SF, Smith, EE, Bhatt, DL, Fonarow, GC, Schwamm, LH. Paradoxical association of smoking with in-hospital mortality among patients admitted with acute ischemic stroke. J Am Heart Assoc. 2013;2(3):e000171.
9.Seymour, CW, Cooke, CR, Heckbert, SR, et al. Prehospital systolic blood pressure thresholds: A community-based outcomes study. Acad Emerg Med. 2013;20(6):597-604.
10.Seymour, CW, Kahn, JM, Cooke, CR, et al. Prediction of critical illness during out-of-hospital emergency care. JAMA. 2010;304(7):747-754.
11.Berger, T, Green, J, Horeczko, T, et al. Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013;14(2):168-174.
12.Seymour, CW, Band, RA, Cooke, CR, et al. Out-of-hospital characteristics and care of patients with severe sepsis: a cohort study. J Crit Care. 2010;25(4):553-562.
13.Guerra, WF, Mayfield, TR, Meyers, MS, Clouatre, AE, Riccio, JC. Early detection and treatment of patients with severe sepsis by prehospital personnel. J Emerg Med. 2013;44(6):1116-1125.
14.Le May, MR, So, DY, Dionne, R, et al. A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2008;358(3):231-240.
15.The National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study Group. A systems approach to immediate evaluation and management of hyperacute stroke. Experience at eight centers and implications for community practice and patient care. Stroke. 1997;28(8):1530-1540.
16.Band, RA, Gaieski, DF, Hylton, JH, Shofer, FS, Goyal, M, Meisel, ZF. Arriving by emergency medical services improves time to treatment endpoints for patients with severe sepsis or septic shock. Acad Emerg Med. 2011;18(9):934-940.
17.Herlitz, J, Bang, A, Wireklint-Sundstrom, B, et al. Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care. Scand J Trauma Resusc Emerg Med. 2012;20:42.
18.Seymour, CW, Cooke, CR, Mikkelsen, ME, et al. Out-of-hospital fluid in severe sepsis: effect on early resuscitation in the emergency department. Prehosp Emerg Care. 2010;14(2):145-152.
19.Seymour, CW, Rea, TD, Kahn, JM, Walkey, AJ, Yealy, DM, Angus, DC. Severe sepsis in pre-hospital emergency care: analysis of incidence, care, and outcome. Am J Respir Crit Care Med. 2012;186(12):1264-1271.
20.Studnek, JR, Artho, MR, Garner, CL Jr, Jones, AE. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. 2012;30(1):51-56.
21.Suffoletto, B, Frisch, A, Prabhu, A, Kristan, J, Guyette, FX, Callaway, CW. Prediction of serious infection during prehospital emergency care. Prehosp Emerg Care. 2011;15(3):325-330.
22.Wang, HE, Weaver, MD, Shapiro, NI, Yealy, DM. Opportunities for emergency medical services care of sepsis. Resuscitation. 2010;81(2):193-197.
23.Baez, AA, Hanudel, P, Perez, MT, et al. Prehospital sepsis project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers. Prehosp Disaster Med. 2013;28(2):104-106.
24.Hanudel, P, Wilcox, SR, Cadin, E, Hou, P, Giraldez, EM, Baez, AA. Prevalence of cryptic shock in a cohort of out-of-hospital sepsis patients: an argument for out-of-hospital point-of-care lactate. Ann Emerg Med. 2008;51(4):487-588.
25.Rivers, E, Nguyen, B, Havstad, S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377.
26.Kumar, A, Roberts, D, Wood, KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589-1596.
27.Seymour, CW, Carlbom, D, Engelberg, RA, et al. Understanding of sepsis among emergency medical services: a survey study. J Emerg Med. 2012;42(6):666-677.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed