Background data for: Pre-hospital identification of infection focus in sepsis and timely empirical antibiotic therapy in a rural ambulance service: A prospective cohort study

This dataset is extracted from an ambulance quality registry of patients with suspected sepsis managed by the ambulance department of the University hospital of Northern Norway. Data was collected from patients with suspected sepsis who were given pre-hospital intravenous antibiotics and transported to hospital by the University of Northern Norways ambulance service from May 2018 to August 2022. The dataset was extracted to conduct a study on whether paramedics with or without assistance of general practitioners are able to identify the infection focus in sepsis patients and administer timely intravenous antibiotic treatment. The dataset contains demographic and clinical data, patient trajectories, treatment given in the prehospital environment, patient status at hospital arrival and at discharge, and 30-day all-cause mortality.
Abstract from corresponding article: Background: Early diagnosis and initiation of intravenous antibiotic therapy in patients with sepsis reduce both morbidity and mortality, thus management of sepsis in the pre-hospital setting is likely to affect patient outcomes. A clear description of pre-hospital sepsis management with emphasis on trajectory and identification of source of infection may contribute to timely and more targeted pre-hospital antibiotic therapy. The aim of this study was to investigate whether paramedics with or without assistance of general practitioners are able to identify the infection focus in sepsis patients and administer timely intravenous antibiotic treatment. Methods: We conducted a cohort study of patients with suspected sepsis who were given pre-hospital intravenous antibiotics and transported to hospital. The setting was mainly rural with long average distance to hospital. Patients received targeted antibiotic treatment after assessment based on clinical work-up supported by scoring systems. Patients were prospectively included from May 2018 to August 2022. Data were registered in a sepsis management ambulance quality registry. Results are presented as median or absolute values. Chi-square tests were used to compare categorised data of source of infection and presence of general practitioners. Results: The study group consisted of 328 patients. Median age was 76 years (IQR 64, 83) and 30-days all-cause mortality was 10.4 %. Antibiotic treatment was initiated at a median of 44 minutes after arrival of ambulance, and median transportation time from place of incident to hospital was 69 minutes. In cases where a suspected source of infection was determined, hospital discharge papers confirmed the pre-hospital diagnosis of infection focus in 195 cases (79.3 %). The presence of a general practitioner during the pre-hospital assessment increased the rate of correctly identified source of infection from 72.6% to 86.1 % (p=0.009). Concordance between pre-hospital identification of a tentative focus and discharge diagnosis was highest for lower respiratory tract (p=0.02) and urinary tract infections (p=0.03). Conclusions: Ambulance personnel are able to identify focus of infection, and start intravenous antibiotics quickly. This is probably of particular value in areas with long transportation times. Collaboration with primary care physicians increases level of diagnostic accuracy.

本数据集提取自挪威北部大学医院急诊部门管理的疑似脓毒症（sepsis）患者救护车质量登记库。数据采集自2018年5月至2022年8月期间，接受院前（pre-hospital）静脉抗生素治疗、并由挪威北部大学医院救护车服务转运至医院的疑似脓毒症患者。本数据集用于开展一项研究，旨在验证有或无全科医师（general practitioners）协助的急救医护人员能否识别脓毒症患者的感染灶并及时给予静脉抗生素治疗。数据集包含人口统计学与临床数据、患者病程轨迹、院前诊疗措施、入院及出院时的患者状态，以及30天全因死亡率。

对应论文摘要：
背景：脓毒症患者早期诊断并启动静脉抗生素治疗可降低并发症发生率与死亡率，因此院前脓毒症管理或可直接影响患者预后。清晰阐述院前脓毒症管理流程，重点关注病程轨迹与感染灶识别，有助于实现及时且更具针对性的院前抗生素治疗。本研究旨在探讨有或无全科医师协助的急救医护人员能否识别脓毒症患者的感染灶并及时给予静脉抗生素治疗。
方法：本研究为队列研究，纳入对象为接受院前静脉抗生素治疗并转运至医院的疑似脓毒症患者。研究场景以农村地区为主，平均就医转运距离较长。患者经临床评估结合评分系统辅助后，接受针对性抗生素治疗。研究对象于2018年5月至2022年8月期间前瞻性纳入，数据登记于脓毒症管理救护车质量登记库。结果以中位数或绝对数值呈现，采用卡方检验（Chi-square tests）比较感染灶分类数据与全科医师参与情况的差异。
结果：本研究共纳入328例患者，年龄中位数为76岁（四分位距IQR：64~83），30天全因死亡率为10.4%。抗生素治疗于救护车抵达后中位数44分钟启动，从事发地点至医院的中位转运时间为69分钟。在确定疑似感染灶的病例中，195例（79.3%）的院前感染灶诊断经出院病历证实。院前评估时有全科医师参与，可将感染灶正确识别率从72.6%提升至86.1%（p=0.009）。院前初步感染灶识别与出院诊断的一致性，在下呼吸道感染（p=0.02）与尿路感染（p=0.03）中最高。
结论：急救医护人员可有效识别感染灶并快速启动静脉抗生素治疗，这在转运距离较长的地区尤为重要。与基层全科医师的协作可提升诊断准确性。