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Background: Severe sepsis is a major cause of mortality in patients evaluated in the Emergency Department (ED). Early initiation of antibiotic therapy and IV fluids in the ED is associated with improved outcomes. We investigated whether early administration of antibiotics in the prehospital setting improves outcomes in these patients with sepsis. Methods: This is a retrospective study comparing outcomes of patients meeting sepsis criteria in the field by EMS, who were treated with IV fluids and antibiotics. Their outcomes were compared with controls where fluids were administered prehospital and antibiotics were initiated in the ED. We compared morbidity and mortality between these groups. Results: Early antibiotics and fluids were demonstrated to show significant improvement in outcomes in the patients meeting sepsis criteria treated in the pre-hospital setting. The average age for sepsis patients receiving antibiotics in the prehospital setting was statistically higher than that for patients in the historical control group, 73.23 years and 67.67, respectively (p < 0.036), and there was no statistically significant difference of Charlson Comorbidity Index between the groups (p two-tail = 0.28). Average intensive care unit length of stay was 2.51 days in the in the prehospital group and 5.18 days in the historical controls, and the prehospital group received fewer blood products than the historical controls (p = 0.0003). Conclusions: Early IV administration of antibiotics in the field significantly improves outcome in EMS patients who meet sepsis criteria based on a modified qSOFA score.
RESUMO
OBJECTIVE: Previous work has shown that the lap belt moves superior and forward compared to the bony pelvis as body mass index (BMI) increases. The goal of this project was to determine whether the location of lap belt loading is related to BMI for occupants who sustained real-world motor vehicle collisions (MVCs). METHODS: A national MVC database was queried for vehicle occupants over a 10-year period (2003-2012) who were at least 16 years old, restrained by a 3-point seat belt, sitting in the front row, and involved in a front-end collision with a change in velocity of at least 56 km/h. Cases were excluded if there was not an available computed tomography (CT) scan of the abdomen. CT scans were then analyzed using adipose enhancement of 3-dimensional reconstructions. Scans were assessed for the presence a radiographic seat belt sign (rSBS), or subcutaneous fat stranding due to seat belt loading. In scans in which the rSBS was present, anterior and superior displacement of rSBS from the anterior-superior iliac spine (ASIS) was measured bilaterally. This displacement was correlated with BMI and injury severity. RESULTS: The inclusion and exclusion criteria yielded 151 cases for analysis. An rSBS could definitively be identified in 55 cases. Cases in which occupants were older and had higher BMI were more likely to display an rSBS. There was a correlation between increasing BMI and anterior rSBS displacement (P <.01 and P <.01, right and left, respectively). There was no significant correlation between BMI and superior displacement of the rSBS (P =.46 and P =.33, right and left, respectively). When the data were examined in terms of relating increasing superior displacement of the lap belt with Injury Severity Scale (P =.34) and maximum Abbreviated Injury Score (AIS) injury severity (P =.63), there was also no significant correlation. CONCLUSION: The results from this study demonstrated that anterior displacement of the radiographic seat belt sign but not superior displacement increased with higher BMI. These results suggest that obesity may worsen horizontal position but not the vertical position of the lap belt loading during real-world frontal MVCs.
