Sepsis incidence, suspicion, prediction and mortality in emergency medical services: a cohort study related to the current international sepsis guideline.

PURPOSE: Sepsis suspicion by Emergency Medical Services (EMS) is associated with improved patient outcomes. This study assessed sepsis incidence and recognition by EMS and analyzed which of the screening tools recommended by the Surviving Sepsis Campaign best facilitates sepsis prediction. METHODS: Retrospective cohort study of claims data from health insurances (n = 221,429 EMS cases), and paramedics' and emergency physicians' EMS documentation (n = 110,419); analyzed outcomes were: sepsis incidence and case fatality compared to stroke and myocardial infarction, the extent of documentation for screening-relevant variables and sepsis suspicion, tools' intersections for screening positive in identical EMS cases and their predictive ability for an inpatient sepsis diagnosis. RESULTS: Incidence of sepsis (1.6%) was similar to myocardial infarction (2.6%) and stroke (2.7%); however, 30-day case fatality rate was almost threefold higher (31.7% vs. 13.4%; 11.8%). Complete vital sign documentation was achieved in 8.2% of all cases. Paramedics never, emergency physicians rarely (0.1%) documented a sepsis suspicion, respectively septic shock. NEWS2 had the highest sensitivity (73.1%; Specificity:81.6%) compared to qSOFA (23.1%; Sp:96.6%), SIRS (28.2%; Sp:94.3%) and MEWS (48.7%; Sp:88.1%). Depending on the tool, 3.7% to 19.4% of all cases screened positive; only 0.8% in all tools simultaneously. CONCLUSION: Incidence and mortality underline the need for better sepsis awareness, documentation of vital signs and use of screening tools. Guidelines may omit MEWS and SIRS as recommendations for prehospital providers since they were inferior in all accuracy measures. Though no tool performed ideally, NEWS2 qualifies as the best tool to predict the highest proportion of septic patients and to rule out cases that are likely non-septic.

Most patients with an increased risk for sepsis-related morbidity or death do not recognize sepsis as a medical emergency: results of a survey study using case vignettes.

BACKGROUND: Sepsis is a medical emergency with potentially life-threatening consequences. Patients play a crucial role in preventing and recognizing sepsis at an early stage. The understanding of risk groups' sepsis knowledge and their ability to use this knowledge to recognize sepsis as an emergency is incomplete. METHODS: We conducted a cross-sectional survey in Germany and included a sample of 740 persons stratified by age (< 60 years, ≥ 60 years), specific chronic diseases (e.g. diabetes, chronic diseases, cancer), and region (Berlin/Brandenburg vs. other federal states of Germany). Standardized questionnaires were administered by a market research institute through online, telephone, or face-to-face methods. We assessed sepsis knowledge through a series of questions and the ability to recognize sepsis as an emergency through five case vignettes. To identify predictors of sepsis knowledge and the ability to recognize sepsis as a medical emergency, we conducted multiple linear regressions. RESULTS: Of the 36 items on sepsis knowledge, participants answered less than 50 per cent correctly (mean 44.1%; standard deviation (SD) 20.1). Most patients knew that sepsis is a defensive host response to infection (75.9%), but only 30.8% knew that vaccination can prevent infections that lead to sepsis. Across the five vignettes, participants identified sepsis as an emergency in only 1.33 of all cases on average (SD = 1.27). Sepsis knowledge was higher among participants who were older, female, and more highly educated and who reported more extensive health information seeking behaviour. The ability to recognize sepsis as an emergency was higher among younger participants, participants without chronic diseases, and participants with higher health literacy, but it was not significantly associated with sepsis knowledge. CONCLUSIONS: Risk groups showed low levels of knowledge regarding the preventive importance of vaccination and a low ability to recognize sepsis as a medical emergency. Higher levels of sepsis knowledge alone were not sufficient to improve the ability to identify sepsis as a medical emergency. It is crucial to develop effective educational strategies-especially for persons with lower education levels and infrequent health information seeking behaviour-that not only transfer but also facilitate the choice of appropriate actions, such as seeking timely emergency care. TRIAL REGISTRATION: DRKS00024561. Registered 9 March 2021.

[White Paper - Improving the care of patients with impairments following sepsis and infections]. / White Paper ­ Verbesserung der Versorgungs- und Behandlungsangebote für Menschen mit Sepsis- und Infektionsfolgen.

Hundreds of thousands of individuals who experience lasting sequelae after sepsis and infections in Germany do not receive optimal care. In this White Paper we present measures for improvement, which were developed by a multidisciplinary expect panel as part of the SEPFROK project. Improved care rests on four pillars: 1. cross-sectoral assessment of sequelae and a structured discharge and transition management, 2. interdisciplinary rehabilitation and aftercare with structural support, 3. strengthening the specific health literacy of patients and families, and 4. increased research into causes, prevention and treatment of sequelae. To achieve this, appropriate cross-sectoral care structures and legal frameworks must be created.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey.

INTRODUCTION: Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. METHODS: The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). RESULTS: The majority of respondents indicated that their EMS use was due to an emergency or someone else's decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians' opening hours) and insecurity/anxiety about one's state of health (>45% of the respondents). "Social factors" were similarly important (e. g., 42% affirming, "No one could give me a ride to the emergency department or doctor's office."). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. CONCLUSION: The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients' insecurity.

[Linking Health Claims Data and Records of Emergency Medical Services: Building a Bridge via Patient's Health Insurance Number?] / Verknüpfung von Abrechnungsdaten gesetzlicher Krankenkassen und Einsatzprotokollen des Rettungsdienstes: Brückenschlag durch Krankenversichertennummer?

INTRODUCTION: In Germany, Emergency Medical Services (EMS) were involved in a total of 7.3 million emergency cases in 2016/2017. Information on prehospital care is stored in several secondary data sources, yet combined analysis of these data at the level of individual patients or EMS cases happens rarely. Research is needed on which methods and variables are suitable for the linkage of these data sources. METHODS: We linked EMS records from five Bavarian emergency service districts to health claims data belonging to ten statutory health insurers (data from 2016). Two linkage approaches at the level of individual patient's EMS case/reimbursement case were demonstrated. First, a deterministic linkage was conducted based on the patient's unique identifying health insurance number. The second linkage was probabilistic. As linkage variables, it comprised the only partially available health insurance number plus several non-unique key variables, the latter being a patient's health insurance provider, sex, year of birth and distance travelled. In order to verify the deterministic and the probabilistic linkages' quality, rates of accordance of several variables present in both data sources were calculated. RESULTS: The starting point for our data linkage were 106,371 EMS records (independent of certain health insurance companies) and 432,693 EMS services reimbursed by health insurers (independent of specific EMS providers). 4,327 EMS records could be linked to health claims data - out of 5,921 EMS records that coded a health insurance company contributing claims data to Inno_RD. With a probabilistic linkage, it was possible to increase this number to a total of 5,379 linked EMS records. All checks carried out indicated a high linkage quality for both the deterministic and the probabilistic approach. CONCLUSION: A linkage of EMS records with health claims data is possible. In Inno_RD, a probabilistic approach has proven a valuable alternative to deterministic linkage via health insurance number since EMS records can be linked meaningfully even if the health insurance number is unavailable or where a minority of non-unique key variables show non-accordance or missing values.

[Left-heart catheterization followed by other invasive procedures: Regional comparisons reveal peculiar differences]. / Linksherzkatheteruntersuchungen und ihre invasive Konsequenz ­ Regionalvergleiche ermitteln auffällige Unterschiede.

BACKGROUND AND AIMS: Diagnostic left heart catheterization (LHC) is recommended if the therapeutic consequences of a bypass operation or percutaneous coronary intervention (PCI) are being considered. The present study examines regional differences in healthcare provision and therapeutic consequences of LHC, differentiated by counties and hospitals of the German federal state of Saxony-Anhalt. In addition, it looks at which patient-related factors influence the proportion of follow-up interventions. The relation between the rates of LHC, interventions and hospital discharge due to myocardial infarction is examined. METHODS: The data of 9,791 individuals having statutory health insurance coverage by the AOK Saxony-Anhalt with 10,906 anonymized inpatient cases of LHCs in 2011 were followed until 12/31/2012, and it was examined whether they subsequently received a coronary bypass or PCI. The data was used to compare both the counties of Saxony-Anhalt (according to residence, adjusted for age and sex) and their hospitals. Regression analysis was run to identify determinants of receiving a LHC without consequences. RESULTS: Overall, 54.2 % of the patients with LHC had no invasive follow-up intervention. Regression analysis showed an approximately linear relationship for the counties: the number of LHCs provided correlates with the number of LHCs requiring no PCI or bypass within a period of at least 12 months. Regional LHC rates are not correlated with hospitalizations due to acute myocardial infarction. No bypass or PCI in the follow-up period was reported for 37 to 85 % of the cases, depending on the hospital providing the LHC. Women and younger patients have a higher risk to undergo LHC without therapeutic impact. DISCUSSION: The analysis indicates that there are specific regions in Saxony-Anhalt and diagnoses where the indications for LHC should be more conservative. However, more detailed analyses are needed to verify the identified potentials for improving healthcare provision.

Case vignettes based on EQ-5D to elicit stated preferences for health services utilization from the insurees' perspective.

BACKGROUND: There is little evidence as to why or why not insurees decide to seek medical services. Steps prior to the entry of the insuree into the professional health care system have not been sufficiently examined and can only be partially described by secondary data of the statutory health insurance (SHI). We report the first investigation using case vignettes based on the generic health-related quality of life questionnaire EQ-5D as part of a choice study to assess insurees' stated preferences in health services utilization. METHODS: We invited 1500 randomly selected citizens (age 30 to 70 years) from the East German state of Saxony-Anhalt by postal mail to participate in the choice study. Attributes of the case vignettes involved in choice tasks were the five dimensions of the EQ-5D. We used multilevel mixed effects logit regression analysis with the dependent variables: preference to seek medical services (model 1) and preferred time until consultation (model 2) for the assessed case vignette. The EQ-5D attributes of the case vignettes and participant characteristics served as the independent variables. We also included the respondent's certainty of choosing from the choice set, and the order of questions of the questionnaire as control variables. RESULTS: Of the 1500 questionnaires 683 were evaluable (net response rate 48.0%). On the level of the case vignettes, problems in all five dimensions of the EQ-5D were statistically significant factors of the estimated likelihood to seek medical services (model 1). On the respondent level, there was a significant relationship between the preference for medical consultation for the assessed case vignette and the respondent's gender, age, educational level, the existence of a regular doctor, and the certainty of choosing from the choice set. Problems in four of the five dimensions of the EQ-5D (except anxiety/depression) of the case vignettes were significantly associated with the preferred time until consultation (model 2). On the respondent level, gender, educational level, the certainty of choosing from the choice set, and the order of questions of the questionnaire were significant determinants of the time until consultation. CONCLUSIONS: Our study offers a promising new approach for the national and cross-national study of preferences in health services utilization from the insurees' perspective.

Theory and practice in medical education--expectations and development of skills experienced by students of human medicine compared with students in other disciplines.

AIM: The aim of this article is to compare students of human medicine (HM) with students specialising in the MINT disciplines (mathematics, computer science, natural sciences and engineering), the humanities and social sciences as well as law and economic sciences with regard to their expectations of their university study and career and the areas of competence where they feel they have been supported by their education. We present in detail issues particularly relevant to prospective physicians, which are discussed with the main focus on the "theoretical and practical orientation of medical education". METHODS: We used the database in the Public Use File of the "11th Student Survey", a written survey of randomly selected students studying at 25 German tertiary institutions during the 2009/2010 winter term, which was supplied by the Tertiary Education Research working group at the University of Constance. Data on 7536 students was included, of which 488 (6.5%) were prospective physicians. RESULTS: Human medicine students have a clear career aim and want to complete their education quickly. They have a far above-average interest in working with and for people. About one student in two is interested in a career in science or research (53% in each case - close to the average for all subjects). Compared with the other disciplines, HM students are most likely to consider their university education to have practical and research relevance and are most likely to feel prepared for their profession. Yet over half of all students (Ø 53.3%; HM 54.5%) do not consider their education to have fostered their research skills. MINT students in particular are better able to enhance their skills through independent experimentation, while theory and practice are more likely to be communicated academically in the regular teaching of human medicine. Accordingly, the HM students feel less well supported in some areas of competence required for their later work than students in other disciplines, in developing independence, problem-solving ability, critical ability and capacity for teamwork for example. CONCLUSION: The high expectations held by human medicine students of being prepared for practical work with/on people are met to an above-average degree according to their assessments of the "practical relevance" and "career preparation" offered by their medical education. However the perceived development of skills in theory and practice does not respond sufficiently well to the demands of the complex, responsible profession they aspire to. Medical students should be better supported in developing both practical and academic independence.