{"pk":9648,"title":"Impact of Prehospital Care on Outcomes in Sepsis: A Systematic Review","subtitle":null,"abstract":"Introduction:\n Sepsis is a common and potentially life-threatening response to an infection. International treatment guidelines for sepsis advocate that treatment be initiated at the earliest possible opportunity. It is not yet clear if very early intervention by ambulance clinicians prior to arrival at hospital leads to improved clinical outcomes among sepsis patients.\nMethods: \nWe systematically searched the electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed up to June 2015. In addition, subject experts were contacted. We adopted the GRADE (grading recommendations assessment, development and evaluation) methodology to conduct the review and follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations to report findings.\nResults:\n Nine studies met the eligibility criteria – one study was a randomized controlled trial while the remaining studies were observational in nature. There was considerable variation in the methodological approaches adopted and outcome measures reported across the studies. Because of these differences, the studies did not answer a unique research question and meta-analysis was not appropriate. A narrative approach to data synthesis was adopted.\nConclusion: \nThere is little robust evidence addressing the impact of prehospital interventions on outcomes in sepsis. That which is available is of low quality and indicates that prehospital interventions have limited impact on outcomes in sepsis beyond improving process outcomes and expediting the patient’s passage through the emergency care pathway. Evidence indicating that prehospital antibiotic therapy and fluid resuscitation improve patient outcomes is currently lacking.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"sepsis, septic shock, Emergency Medical Services, prehospital, paramedic"}],"section":"Prehospital Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/2gw6g83b","frozenauthors":[{"first_name":"Michael","middle_name":"A.","last_name":"Smyth","name_suffix":"","institution":"University of Warwick, Clinical Trials Unit, Coventry, England","department":"None"},{"first_name":"Samantha","middle_name":"J.","last_name":"Brace-McDonnell","name_suffix":"","institution":"University of Warwick, Clinical Trials Unit, Coventry, England","department":"None"},{"first_name":"Gavin","middle_name":"D.","last_name":"Perkins","name_suffix":"","institution":"University of Warwick, Clinical Trials Unit, Coventry, England","department":"None"}],"date_submitted":"2016-02-23T02:49:57-08:00","date_accepted":"2016-02-23T02:49:57-08:00","date_published":"2016-07-05T11:57:54-07:00","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/9648/galley/5358/download/"}]}