ACTSI Studio Helps to Develop a Screening Tool for Prehospital Recognition of Sepsis

Patients transported by EMS to Grady participated in the study

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Early recognition of sepsis is necessary in order to initiate timely, life-saving treatment. With this in mind, Carmen Polito, MD, MSc, an Atlanta Clinical & Translational Science Institute (ACTSI) investigator, graduate of the ACTSI Master of Science in Clinical Research (MSCR) program, and assistant professor of medicine at Emory University, designed a study to develop and validate a screening tool for emergency medical service (EMS) providers to detect sepsis in the field. This study, published in the American Journal of Emergency Medicine, identified patients at risk for sepsis who were transported via EMS to Grady Memorial Hospital between 2011 and 2012.

ACTSI supported this work through a Studio Consultation by the Georgia CTSA Clinical Research Centers (GCRCs), Biomedical Informatics Program (BIP), and Biostatistics, Epidemiology, & Research Design (BERD) program, and through GCRCs support of the Research Electronic Data Capture tool (REDCap). “My initial Studio Consultation was incredibly helpful in connecting me to different people across campus and orienting me to what resources were available for my project,” said Polito. “The Studio Consultation helped in the planning phase of the project, and in building the infrastructure for data collection with our REDCap database.”

For this study, mathematical models were used to determine which patient and EMS characteristics were most predictive of the patient having sepsis. The models identified several risk factors most predictive of sepsis, including: older age, emergency medical dispatch 9-1-1 chief concern category of “sick person,” transport from a nursing home, hot tactile temperature, low systolic blood pressure, and low oxygen saturation. The authors then developed a score called the prehospital severe sepsis (PRESS) score, based on these risk factors.  The PRESS score was able to identify severe sepsis with 86% sensitivity and 47% specificity. “There is a need for early identification of sepsis in order to both facilitate and optimize timely lifesaving treatment for patients; however, there are no current standards for EMS providers to use to recognize sepsis in the field,” said Polito. “While validation in additional populations is required before this tool is put into widespread use, we hope the tool will lead to more rapid emergency department triage so that these patients receive necessary therapies as quickly as possible.” 

In light of the success of her initial Studio Consultation, Polito has since had additional ACTSI Studio Consultations for subsequent projects. She again met with GCRCs and BERD leaders for her follow-up study. “The Studio Consultation allowed me to receive expert feedback on the study design and analysis plan for my follow-up study which is focused on training paramedics to use the PRESS screening tool, and determining whether EMS sepsis screening is beneficial to patients. We want to see if prehospital sepsis recognition improves with the tool and whether treatment is delivered more quickly in the emergency department if emergency room providers are alerted to incoming patients with potential sepsis,” said Polito.  She continues to work with the BERD program on the analysis of qualitative data from a survey of the utilization of the tool among EMS providers.  She also consulted with BERD health economist Jason Hockenberry, PhD on the implications for healthcare utilization from the change in work flow for EMS providers. “You could call me a repeat offender. I have found the Studio Consultation to be invaluable to my research process, and I continue to use this resource.”

Studio Consultations aid in the successful design and implementation of clinical and translational science research proposals. The Studio Consultation concept involves a clinical investigator(s) presenting their proposals to representatives of the BERD, BIP, and GCRCs who in-turn give the investigator their expert feedback. By pulling together experts from these key programs, ACTSI hopes to improve a proposal's design, implementation, and analysis to maximize competitiveness. In short, a Studio Consultation is a pre-review by a panel of experts designed to improve an investigator's chances of success. A Studio will assist researchers in biostatistics, bioinformatics, database development, project generation planning, research design, and/or protocol planning and implementation. Consultations are available to researchers at Emory University, Morehouse School of Medicine, or Georgia Institute of Technology. 

The Emory Master of Science in Clinical Research (MSCR) degree program, from the Laney Graduate School at Emory University, provides didactic and mentored clinical and translational research training.  The degree is designed for participants at Emory University and Georgia Tech who hold a doctorate or equivalent degree (such as physicians and PhD-level scientists) or predoctoral trainees enrolled in a dual degree program (MD/MSCR and PhD/MSCR tracks) and have demonstrated a commitment to a career in clinical investigation. The ACTSI is a city-wide partnership between Emory, Morehouse School of Medicine, and Georgia Institute of Technology and is one of a national consortium striving to improve the way biomedical research is conducted across the country.  The consortium, funded through the National Center for Advancing Translational Sciences as one of the National Institutes of Health’s Clinical and Translational Science Awards, shares a common vision to translate laboratory discoveries into treatments for patients, engage communities in clinical research efforts, and train the next generation of clinical investigators.

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