Out-of-hospital characteristics and care of patients with severe sepsis: a cohort study

J Crit Care. 2010 Dec;25(4):553-62. doi: 10.1016/j.jcrc.2010.02.010. Epub 2010 Apr 8.


Purpose: Early recognition and treatment in severe sepsis improve outcomes. However, out-of-hospital patient characteristics and emergency medical services (EMS) care in severe sepsis is understudied. Our goals were to describe out-of-hospital characteristics and EMS care in patients with severe sepsis and to evaluate associations between out-of-hospital characteristics and severity of organ dysfunction in the emergency department (ED).

Materials and methods: We performed a secondary data analysis of existing data from patients with severe sepsis transported by EMS to an academic medical center. We constructed multivariable linear regression models to determine if out-of-hospital factors are associated with serum lactate and sequential organ failure assessment (SOFA) in the ED.

Results: Two hundred sixteen patients with severe sepsis arrived by EMS. Median serum lactate in the ED was 3.0 mmol/L (interquartile range, 2.0-5.0) and median SOFA score was 4 (interquartile range, 2-6). Sixty-three percent (135) of patients were transported by advanced life support providers and 30% (62) received intravenous fluid. Lower out-of-hospital Glasgow Coma Scale score was independently associated with elevated serum lactate (P < .01). Out-of-hospital hypotension, greater respiratory rate, and lower Glasgow Coma Scale score were associated with greater SOFA (P < .01).

Conclusions: Out-of-hospital fluid resuscitation occurred in less than one third of patients with severe sepsis, and routinely measured out-of-hospital variables were associated with greater serum lactate and SOFA in the ED.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Academic Medical Centers
  • Aged
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Humans
  • Lactic Acid / blood*
  • Male
  • Middle Aged
  • Multiple Organ Failure*
  • Outcome and Process Assessment, Health Care*
  • Regression Analysis
  • Retrospective Studies
  • Sepsis / therapy*
  • Shock, Septic


  • Lactic Acid