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Sepsis erkennen im Rettungsdienst

Ergebnisse einer interprofessionellen Befragung zur präklinischen und frühen innerklinischen Sepsiserkennung

Sepsis detection in emergency medicine

Results of an interprofessional survey on sepsis detection in prehospital emergency medicine and emergency departments

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Zusammenfassung

Hintergrund

Sepsis hat eine hohe Mortalität, die durch einen frühzeitigen Therapiebeginn reduziert werden kann. Da Patienten mit Sepsis häufig durch den Rettungsdienst in die Notaufnahme gebracht werden, kann hier die Therapie schon gebahnt werden.

Fragestellung

Ist das Wissen zum Erkennen und Screenen der Sepsis in der Notfallmedizin ausreichend verbreitet?

Material und Methoden

Im Rahmen einer Befragungsstudie wurde im Landkreis Vorpommern-Greifswald das Wissen zur Sepsiserkennung bei ärztlichen und nichtärztlichen Mitarbeitern der Rettungswachen, Leitstelle und Notaufnahme ermittelt.

Ergebnisse und Diskussion

Eine Vielzahl des nichtärztlichen Rettungsdienstpersonals und der Leitstellendisponenten hatte noch nie eine Schulung zum Thema Sepsis. Der Sepsis-Score quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) ist wenig bekannt, und der Parameter „alterierter Mentalstatus“ wird kaum mit dem Krankheitsbild Sepsis assoziiert. Damit besteht die Gefahr, Patienten mit Sepsis in der präklinischen und frühen innerklinischen Versorgung zu übersehen und so den Therapiebeginn zu verzögern. Eine verbesserte Sepsisausbildung und Erhöhung der Aufmerksamkeit in der präklinischen und frühen innerklinischen Notfallmedizin könnten die Prognose der Sepsis verbessern.

Abstract

Background

Sepsis is associated with a high mortality, which can be reduced by starting screening, diagnostics and treatment as early as possible. Due to multiple educational programs and increased awareness, a decreased sepsis mortality on intensive care units has been achieved. Many patients with sepsis are admitted by the prehospital emergency service to hospital emergency departments. Thus, prehospital emergency services and emergency departments provide an opportunity to start screening, diagnosis and treatment earlier.

Objectives

To detect sepsis it is paramount that emergency personnel are aware of the disease and have a profound knowledge regarding symptoms, screening and diagnostics. The objective of this survey was to examine the state of knowledge regarding sepsis among staff working in emergency medicine.

Material and methods

To assess the awareness and knowledge, a paper-based, anonymous survey was conducted among prehospital and emergency department personnel from May to August 2017 in northeastern Germany. Testing of significance was carried out using the χ2-testand Fisher’s exact test.

Results

Out of 411 persons polled 212 answered (response rate 51.6%) and 24 questionnaires were incomplete and thus excluded. A total of 188 questionnaires were included covering 55 emergency physicians, 23 nurses, 82 paramedics and 19 emergency dispatchers. On a 4-point Likert scale 100% of emergency doctors, 96% of nurses, 84% of paramedics and 84% of emergency dispatchers considered early initiation of sepsis treatment to be important. Additionally, 92% of emergency physicians and 65% of nurses had attended educational programs on sepsis within the last year, which is significantly higher than among paramedics (19%, p < 0.01) and emergency dispatchers (21%, p = 0.025). In addition, 38% of paramedics and 47% of emergency dispatchers had never attended lectures on sepsis. The quick sequential (sepsis-related) organ failure assessment (qSOFA) was known by 80% of emergency doctors, thus, significantly more often than by nurses (26%), paramedics (29%) and emergency dispatchers (29%, p < 0.01). The emergency personnel were asked to tick all symptoms they associated with sepsis from a display of 14 symptoms. Among all occupation groups the majority selected “increased body temperature”, “drop in blood pressure” and “altered breathing”. In relation to “increased body temperature” the symptom “altered mental status” was selected significantly more frequently by emergency doctors than by nurses and paramedics (p = 0.02 and p < 0.01, respectively). The combination of at least all 3 qSOFA parameters was selected significantly more often by emergency doctors (62%) than by nurses (13%) and paramedics (10%, p = 0.017 and p < 0.01, respectively).

Conclusion

Although emergency personnel rated an early initiation of sepsis treatment as important, sepsis knowledge was limited. While the majority of emergency doctors and many nurses had attended educational programs on sepsis within the last year, an alarmingly high percentage of paramedics and emergency dispatchers had never received sepsis education. Emergency personnel are mostly unfamiliar with the qSOFA score and did not associate an altered mental status with sepsis. In light of the high sepsis morbidity and mortality, further achievements might be made by initiating sepsis screening and diagnostics in the prehospital setting. Analogous to advancements in intensive care units, increased educational programs for emergency personnel might lead to an earlier detection and improved prognosis of sepsis.

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Danksagung

Die Autoren bedanken sich bei Rebekka Süss, Jan Bartels, Marcel Fleig und Jan Hübner für die Unterstützung bei der Datenerhebung und bei allen weiteren Mitgliedern der Arbeitsgruppe „Forschung in der Notfallmedizin“ der Klinik für Anästhesiologie der Universitätsmedizin Greifswald für die konstruktiven Anregungen.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland

    C. Metelmann, B. Metelmann, C. Scheer, M. Gründling, B. Henkel, K. Hahnenkamp & P. Brinkrolf

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  1. C. Metelmann
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  2. B. Metelmann
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  3. C. Scheer
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  4. M. Gründling
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Correspondence to C. Metelmann.

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Interessenkonflikt

C. Metelmann, B. Metelmann, C. Scheer, M. Gründling, B. Henkel, K. Hahnenkamp und P. Brinkrolf geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Ein positives Votum der Ethikkommission der Universitätsmedizin Greifswald mit dem Aktenzeichen BB 056/17 vom 25.04.2017 liegt vor.

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Metelmann, C., Metelmann, B., Scheer, C. et al. Sepsis erkennen im Rettungsdienst. Anaesthesist 67, 584–591 (2018). https://doi.org/10.1007/s00101-018-0456-z

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  • DOI: https://doi.org/10.1007/s00101-018-0456-z

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