ArticleEmergency medicine journal : EMJ2023
Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study.
Article in Emergency medicine journal : EMJ, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 15 citations in OpenAlex.
- qREDS score compared with the REDS and NEWS2 scores to risk-stratify emergency department suspected sepsis patients for in-hospital mortality and 168-hour survival probability: a retrospective cohort study.BMJ open quality · 2026Article
- Impact of United Kingdom guidelines for stratification of risk in adult hospital inpatients identified with sepsis - an observational cohort study.BMC infectious diseases · 2026Observational
- Association between daily vital signs during radiotherapy and severe infection in cancer patients: A case-control study.Medicine · 2026Article
- Integrated counter current separation and omics approaches for discovery of bioactive compounds from medicinal plants.Frontiers in pharmacology · 2026Review
- Prehospital lactate analysis in suspected sepsis improves detection of patients with increased mortality risk: an observational study.Critical care (London, England) · 2025Observational
- [Sepsis in emergency medical services : A cohort study on screening, incidence, and mortality].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Article
- How do emergency departments respond to ambulance pre-alert calls? A qualitative exploration of the management of pre-alerts in UK emergency departments.Emergency medicine journal : EMJ · 2024Article
- Article
- Recognition and Awareness of Sepsis by First-Aid Providers in Adults With Suspected Infection: A Scoping Review.Cureus · 2024Article
- Diagnostic accuracy of early warning system scores in the prehospital setting.Journal of paramedic practice : the clinical monthly for emergency care professionals · 2023Article
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Authors and funding
16 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAmbulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment.
methodsWe undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019. We used routine ambulance service data to calculate 21 early warning scores and categorise paramedic diagnostic impressions as sepsis, infection, non-specific presentation or other presentation. We linked cases to hospital records and identified those meeting the sepsis-3 definition who received urgent hospital treatment for sepsis (reference standard). Analysis determined the accuracy of strategies that combined early warning scores at varying thresholds for positivity with paramedic diagnostic impression.
resultsWe linked 12 870/24 955 (51.6%) cases and identified 348/12 870 (2.7%) with a positive reference standard. None of the strategies provided sensitivity greater than 0.80 with positive predictive value greater than 0.15. The area under the receiver operating characteristic curve for the National Early Warning Score, version 2 (NEWS2) applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% CI 0.729, 0.783). No other early warning score provided clearly superior accuracy to NEWS2. Paramedic impression of sepsis or infection had sensitivity of 0.572 (0.519, 0.623) and positive predictive value of 0.156 (0.137, 0.176). NEWS2 thresholds of >4, >6 and >8 applied to patients with a diagnostic impression of sepsis or infection, respectively, provided sensitivities and positive predictive values of 0.522 (0.469, 0.574) and 0.216 (0.189, 0.245), 0.447 (0.395, 0.499) and 0.274 (0.239, 0.313), and 0.314 (0.268, 0.365) and 0.333 (0.284, 0.386).
conclusionNo strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. TRIAL REGISTRATION NUMBER: researchregistry5268, https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/5de7bbd97ca5b50015041c33/.
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