Increasing alertness in ambulances to diagnose sepsis more quickly (MUMC+ news)

Rapid recognition of blood poisoning halves the risk of death

By recognising blood poisoning on time, while still in the ambulance, the chance of survival significantly increases in an unhealthy situation. That is the conclusion of doctoral research conducted by internist/researcher Lianne Roest from Maastricht UMC+.

Blood poisoning, also called sepsis, is a severe, life-threatening reaction of the body to an infection. The infection itself can have various causes, such as a bladder infection or a boil. Since sepsis worsens very quickly and can lead to death, rapid diagnosis is extremely important.

A difficult diagnosis

The symptoms of sepsis are quite variable, making the disorder difficult to recognise as such. According to international standards, the diagnosis can be quickly made based on the frequency of the heart rate and breathing, the amount of carbon dioxide in the blood and the body temperature. Roest discovered that the ‘clinical eye’ of the doctor in the emergency department more often identified patients with sepsis than the internationally used diagnostic definition. A diagnosis according to the quick criteria is correct in 80 percent of cases, while one made by the ‘clinical eye’ of the doctor in the emergency department is correct in 88 percent of cases.

Late diagnosis

In the chain of acute medical care, the diagnosis is regularly made too late. Roest's research found that for 60 percent of patients with sepsis, the diagnosis was already known in the ambulance. Of those patients, 13 percent died. Of the people who were only diagnosed in the hospital, 26 percent died. A timely diagnosis thus halves the mortality risk. Roest speculates on the reasons for this: ‘When sepsis is already thought about in the ambulance, perhaps because the doctor relayed that in the 112 message or the ambulance personnel themselves noticed it, the patients receive more effective treatment. The emergency department also pays immediate attention to the patient’s serious condition, causing care to begin more quickly.’ According to Roest, the recognition of sepsis in the ambulance can increase to 80 percent by training ambulance personnel to recognise the condition.

Acute internal medicine

To further improve the care of patients with sepsis, multiple follow-up studies are underway at Maastricht UMC+. Research leader and acute care internist Patricia Stassen: ‘We are the co-initiators of a national study investigating whether the survival rate of patients with sepsis would improve if they started antibiotic treatment in the ambulance. We are also working on a computerised decision model that issues a warning when a patient meets certain sepsis criteria.’

A new field of study

Roest was the first Dutch PhD student in the new field of acute internal medicine. Stassen: ‘Acute medicine takes care of the sickest internal medicine patients. Through research we want to improve the care and safety of these patients. The research into sepsis fits perfectly into this strategy.’

Lianne Roest received her PhD at Maastricht University on 13 January 2016. Her PhD dissertation was titled Emergency Care in Sepsis Patients.

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