Evaluation of the PRESEP Score and the Miami Sepsis Score for Prehospital Sepsis Screening

Abstract

Introduction

Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to an infection that requires early intervention. Prehospital sepsis screening tools have not yet been widely evaluated for their performance in clinical practice.

Objective

To evaluate the ability of the Prehospital Early Sepsis Detection (PRESEP) score and the Miami Sepsis Score to predict sepsis in prehospital settings.

Method

This retrospective analysis included patients with diseases of internal cause who were transported by emergency medical services (EMS) to the hospital and hospitalized between January and June 2020. Data were extracted from the medical and EMS records. The primary outcome was sepsis diagnosis within 48 h of admission. The predictive abilities of the scores were assessed using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated at cutoff values derived using Youden’s index.

Results

Data from 354 patients were analyzed. The AUC for the PRESEP score was 0.83 (95% confidence interval [CI] 0.79–0.88) while that for the Miami Sepsis Score was 0.80 (0.75–0.85). The sensitivity, specificity, positive LR, and negative LR for the PRESEP score (cutoff was 5) were 0.83 (0.73–0.90), 0.68 (0.62–0.73), 2.59 (2.12–3.16), and 0.25 (0.15–0.40), respectively, and those for the Miami Sepsis Score (cu-off was 3) were 0.81 (0.71–0.89), 0.65 (0.59–0.71), 2.33 (1.93–2.83), and 0.30 (0.19–0.46), respectively.

Conclusion

Due to their relatively good predictive abilities to detect septic patients and simplicities, the PRESEP and Miami Sepsis Scores could be used for screening patients for sepsis in prehospital settings. Further prospective validation and evaluation of effect on clinical outcomes are needed.

Data Availability Statement

The research protocol approved by the ethics committee does not allow data sharing.

Disclosure Statement

The authors declare no conflicts of interest

Ethical Clearance

The ethics committee of Khon Kaen Hospital approved the study protocol and waived informed consent from the participants because of the retrospective nature of this study.

Additional information

Funding

This study was supported by the Japan Society for the Promotion of Science KAKENHI (19K09403); the funding body did not play any role in the study or preparation of the manuscript.