| 1. |
- Brink, Magnus, et al.
(författare)
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Nu gäller Sepsis-3 för definitioner och diagnostiska kriterier : [New definition of and diagnostic criteria for sepsis – Swedish use of Sepsis-3]
- 2018
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Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 115
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Forskningsöversikt (refereegranskat)abstract
- A working group representing the Swedish Society for Infectious Diseases, the Swedish Society for Anaesthesiology and Intensive Care, the Swedish Society for Emergency Medicine, and the Swedish Intensive Care Registry have reached consensus on how to adopt the new sepsis definition, Sepsis-3, in Sweden. The recommendation is to implement the new definitions and diagnostic criteria for sepsis and septic shock, but not the use of the new screening tool for sepsis, quick-SOFA, as it needs prospective validation and since it is not clear if quick-SOFA is more useful than the currently used general triage and early warning score systems. The group recommends the use of the sfollowing ICD-10 codes: R65.1 for sepsis and R57.2 for septic shock.
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| 2. |
- Strålin, Kristoffer, et al.
(författare)
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Design of a national patient-centred clinical pathway for sepsis in Sweden
- 2023
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Ingår i: Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 2374-4243. ; 55:10, s. 716-724
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis.METHODS: The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis.RESULTS: The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems.CONCLUSION: A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.
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| 3. |
- Dryver, Eric, et al.
(författare)
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The Swedish specialist examination in emergency medicine : form and function
- 2017
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 24:1, s. 19-24
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Tidskriftsartikel (refereegranskat)abstract
- AIM/BACKGROUND: The purpose of the Swedish specialist examination in Emergency Medicine is not only to determine whether residents have attained the level of competence of specialists, but also to guide and facilitate residency training.METHODS: The Swedish Society for Emergency Medicine has developed checklists that delineate criteria of consideration and action items for particular processes. These checklists are freely available and used to assess competence during the examination. They are also intended for use during teaching and clinical care, thus promoting alignment between clinical practice, teaching and assessment. The examination is carried out locally by residency program educators, thereby obviating travel expenses. It consists of a total of 24 stations and over 100 potential scenarios, thereby minimizing case specificity. Each station consists of a scenario based on a real case. The checklists allow for direct feedback to the examinee after each station.RESULTS AND CONCLUSION: This model may be of interest to other European countries.
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| 4. |
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| 5. |
- Möller, Anders, et al.
(författare)
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The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town
- 2018
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Ingår i: African Journal of Emergency Medicine. - : Elsevier. - 2211-419X. ; 8:3, s. 89-94
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.Methods: The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of < 0.05 was deemed significant.Results: The majority of patients were 19-44 year old males (n=427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n=343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a. m. In-hospital mortality (n=18, 3.4%) was not significantly affected by transport method (p=0.26), hospital arrival time (p=0.22) or prehospital transport time intervals (all p-values > 0.09).Discussion: Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate.
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| 6. |
- Wallgren, Ulrika M., 1971-, et al.
(författare)
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Association between variables measured in the ambulance and in-hospital mortality among adult patients with and without infection : a prospective cohort study
- 2022
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Ingår i: BMC Emergency Medicine. - : BioMed Central (BMC). - 1471-227X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients presenting with infection to the ambulance are common, but risk factors for poor outcome are not known. The primary aim of the current study was to study the association between variables measured in the ambulance and mortality among adult patients with and without infection. The secondary aim was to study the association between these variables and mortality in a subgroup of patients who developed sepsis within 36 h.METHODS: Prospective cohort study of 553 ambulance patients with, and 318 patients without infection, performed in Stockholm during 2017-2018. The association between 21 variables (8 keywords related to medical history, 6 vital signs, 4 blood tests, and age, gender, comorbidity) and in-hospital mortality was analysed using logistic regression.RESULTS: Among patients with infection, inability of the patient to answer questions relating to certain symptoms such as pain and gastrointestinal symptoms was significantly associated with mortality in univariable analysis, in addition to oxygen saturation < 94%, heart rate > 110 /min, Glasgow Coma Scale (GCS) < 15, soluble urokinase Plasminogen Activator Receptor (suPAR) 4.0-7.9 ng/mL, suPAR ≥ 8.0 ng/mL and a Charlson comorbidity score ≥ 5. suPAR ≥ 8.0 ng/mL remained significant in multivariable analysis (OR 25.4; 95% CI, 3.2-199.8). Among patients without infection, suPAR ≥ 8.0 ng/mL and a Charlson comorbidity score ≥ 5 were significantly associated with mortality in univariable analysis, while suPAR ≥ 8.0 ng/mL remained significant in multivariable analysis (OR 56.1; 95% CI, 4.5-700.0). Among patients who developed sepsis, inability to answer questions relating to pain remained significant in multivariable analysis (OR 13.2; 95% CI, 2.2-78.9), in addition to suPAR ≥ 8.0 ng/mL (OR 16.1; 95% CI, 2.0-128.6).CONCLUSIONS: suPAR ≥ 8.0 ng/mL was associated with mortality in patients presenting to the ambulance both with and without infection and in those who developed sepsis. Furthermore, the inability of the ambulance patient with an infection to answer questions relating to specific symptoms was associated with a surprisingly high mortality. These results suggest that suPAR and medical history are valuable tools with which to identify patients at risk of poor outcome in the ambulance and could potentially signal the need of enhanced attention.TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .
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| 7. |
- Wallgren, Ulrika M., 1971-, et al.
(författare)
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Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection : a prospective cohort study
- 2021
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 29:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment.METHODS: Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong's test.RESULTS: The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87-0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39-0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75-0.77) was similar.CONCLUSIONS: The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation.TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .
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| 8. |
- Wallgren, Ulrika Margareta, et al.
(författare)
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Presentations of adult septic patients in the prehospital setting as recorded by emergency medical services : a mixed methods analysis
- 2017
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - London, United Kingdom : BioMed Central. - 1757-7241. ; 25:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current sepsis screening tools rely on vital parameters which are, however, normal in one third of patients with serious infections. Therefore, there is a need to include other variables than vital parameters to identify septic patients. Our primary aim was to identify and quantify keywords related to the septic patients' symptom presentation in the prehospital setting. The secondary aims were to compare keywords in relation to in-hospital mortality and the distribution of keywords in relation to age categories, survivors/ deceased and severe/ non-severe sepsis.Methods: A mixed methods analysis using a sequential exploratory design was performed, starting with a content analysis of presentations of septic patients as documented in Emergency Medical Services (EMS) records (n = 80) from 2012, to identify keywords related to sepsis presentation. Thereafter, the identified keywords were quantified among 359 septic patients from 2013. All patients were adults, admitted to Södersjukhuset and discharged with an ICD-10-code (International Classification of Diseases, Tenth Revision) compatible with sepsis.Results: The most common keywords related to septic patients' symptom presentation were: abnormal/ suspected abnormal temperature (64.1.%), pain (38.4%), acute altered mental status (38.2%), weakness of the legs (35.1%), breathing difficulties (30.4%), loss of energy (26.2%) and gastrointestinal symptoms (24.0%). There was an association between keywords and in-hospital mortality. Symptoms varied between age categories, survivors/ deceased and severe/ non-severe sepsis.Discussion: This is, to the best of our knowledge, the first study exploring the symptom presentation as documented by EMS, of septic patients in the prehospital setting. Keywords related to patients´ symptom presentation recurred in the EMS records of septic patients, so that a pattern was discernible. In addition, certain symptom presentations were associated with increased in-hospital mortality CONCLUSIONS: Information relating to symptom presentation is not included in current sepsis screening tools. We suggest that keywords related to patients´ symptom presentation could be integrated into screening tools and may thus increase the identification of sepsis, and potentially also identify high-risk patients. However, as a first step, the specificity of these keywords, with respect to sepsis, needs to be examined.
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| 9. |
- Wallgren, Ulrika Margareta, et al.
(författare)
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The predictive value of variables measurable in the ambulance and the development of the Predict Sepsis screening tools : a prospective cohort study
- 2020
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central. - 1757-7241. ; 28:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite sepsis being a time critical condition with a high mortality, it is often not identified in a timely fashion. The aim of the current study was to create a screening tool based on bedside measurable variables predictive of sepsis among ambulance patients with infection according to clinical judgment by ambulance personnel.Methods: Prospective cohort study of 551 adult patients presenting with suspected infection, performed in the ambulance setting of Stockholm during 2017-2018. 18 variables were measured in the ambulance (8 keywords related to medical history, 6 vital signs, 4 point-of-care blood tests, in addition to age, gender, and comorbidity. Logistic regression, area under the curve (AUC) and classification trees were used to study the association with sepsis. The AUC, sensitivity, specificity, predictive values and likelihood ratios were used to evaluate the predictive ability of sepsis screening models.Results: The six variables with the strongest association with sepsis were: systolic blood pressure <= 100 mmHg, temperature > 38.5 degrees C, GCS < 15, lactate > 4 mmol/L, gastrointestinal symptoms, and a history of acute altered mental status. These were combined into thePredict Sepsis screening tool 1, with a sensitivity of 0.90, specificity 0.41, AUC 0.77; 95% confidence interval [CI] 0.73-0.81, PPV 0.52, and NPV 0.86. Combining a history of acute altered mental status with GCS < 15 and excluding lactate in thePredict Sepsis screening tool 2did not noticeably affect the AUC. In addition, the AUCs of these models did not differ noticeably when compared to a model including vital signs alone, with novel calculated cut-offs; thePredict Sepsis screening tool 3.Conclusions: Systolic blood pressure <= 100 mmHg, temperature > 38.5 degrees C, GCS < 15, lactate > 4 mmol/L, gastrointestinal symptoms, and a history of acute altered mental status demonstrated the strongest association with sepsis. We present three screening tools to predict sepsis with similar sensitivity. The results indicated no noticeable increase of predictive ability by including symptom-variables and blood tests to a sepsis screening tool in the current study population.
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| 10. |
- Andersson, Jonas, 1983-, et al.
(författare)
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Long emergency department length of stay : A concept analysis
- 2020
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Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 53
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Emergency Department (ED) Length of stay (LOS) has been associated with poor patient outcomes, which has led to the implementation of time targets designed to keep EDLOS below a specific limit. The cut-offs defining long EDLOS varies across settings and seem to be arbitrarily chosen. This study aimed to clarify the meaning of long EDLOS.METHODS: A concept analysis using the Walker and Avant approach was conducted. It included a literature search aiming to identify all uses of the concept, resulting in a set of defining attributes and a way of measuring the concept empirically.RESULTS: Long EDLOS was primarily used as proxy for other phenomena, e.g. boarding or crowding. The definitions had cut-offs ranging between 4 and 48 h. The attributes defining long EDLOS was waiting, a crowded ED environment and an inefficient organization.DISCUSSION: Time targets are probably more suitable when directed towards and tailored for specific sub-groups of the ED population.
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