Evidence for Use of Validated Sepsis Screening Tools in the Prehospital Setting: A Systematic Search and Narrative Review

Introduction: Early detection and treatment of sepsis drastically improves chances of survival. Inpatient detection of sepsis can be delayed, sometimes resulting in grim outcomes. This is especially true in the prehospital setting, where resources are scarce, and time is of great significance. Early Warning Scores (EWS), based on vital signs, were initially developed to guide medical practitioners in determining the degree of illness of a patient in the in-patient setting. These were adapted for use in the prehospital setting to predict critical illness and sepsis, however, they are not consistently used since Emergency Medical Services (EMS) are ill-equipped to use them primarily due to lack of resources and satisfactory training. We performed a systematic search and narrative review to evaluate the existing evidence for use of validated sepsis screening scores to identify prehospital sepsis. Methods: We performed a comprehensive literature search using the CINAHL, Embase, Ovid-MEDLINE, and PubMed databases on April 22, 2022. Articles that examined the use of EWS to identify prehospital sepsis were included and assessed. Results: A total of 23 studies were included in this review: one validation study, two prospective, two systematic reviews, and 18 were retrospective studies. Study characteristics, disease screening statistics (such as sensitivities, specificities, positive and negative predictive values), and primary conclusions of each were extracted and tabulated. Sensitivities ranging from 0.02-1.00, specificities ranging from 0.07-1.00, PPV and NPV (0.19-0.98 and 0.32-1.00, respectively) for identifying sepsis were reported. Conclusions: All studies performed poorly and inconsistently in the identification of prehospital sepsis. Given the vast variety of available EWS and heterogeneity in their usage, it would be unlikely for new research to isolate a single gold standard score or create a new score that would become the gold standard. This review suggests forgoing incorporation of EWS and instead offering enhanced personnel training in identifying critical illness and additional guidance in early management. It is in the best interest of public health experts and of public health significance to continue investigating the prehospital identification and treatment of sepsis to prevent morbidity and mortality due to sepsis