Does Prehospital Suspicion of Sepsis Shorten Time to Administration of Antibiotics in the Emergency Department? A Retrospective Study in One University Hospital.

Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten the time for antibiotic administration in the emergency department. We retrospectively evaluated all patients above 18 years of age who were diagnosed with sepsis or severe infection in our emergency department between 2018 and 2020. We recorded the suspected diagnosis at the time of presentation, the type of referring healthcare provider, and the time until initiation of antibiotic treatment. Differences between groups were calculated using the Kruskal-Wallis rank sum test. Of the 277 patients who were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients, and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections (p = 0.022) and sepsis (p = 0.004). Given the well-described outcome benefits of early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce the time to antibiotic administration and improve patient outcomes.

[Medical civil protection in Germany-a Greek tragedy?] / Medizinischer Bevölkerungsschutz in Deutschland ­ eine griechische Tragödie?

In terms of civil protection, there is nothing against self-critical reflection of events, such as the coronavirus disease 2019 pandemic, and learning lessons from them. In the past, however, this has often not led to anticipating future situations, their consequences, and better preparation. To some extent, this seems like a Greek tragedy: conscious disregard-except that this must not be fate. In addition to pandemics, important scenarios for which civil protection in Germany is inadequately prepared, according to the author's assessment, include attacks and accidents involving CBRN (chemical, biological, radiological, nuclear) hazardous substances, mass casualties in the event of a terror attack with hospitals or rescue services as the target of the attacks, as well as prolonged power or drinking water failures, and disruptions in information and communication structures following cyberattacks. There is an urgent need to identify existing problems and demand functional concepts for hospitals, rescue services, and rapid response teams. Responsible authorities, in turn, must develop, finance, and implement concepts.

Differences in training among prehospital emergency physicians in Germany.

Background: Germany has an interdisciplinary physician-based emergency medical service. Differences in training likely lead to different levels of expertise. Objectives: We assessed the number of manual procedures performed at the completion of training to determine level of experience of prehospital emergency physicians of different primary specialties. Materials and methods: Immediately after passing the board examination each examinee was asked to estimate the number of performed procedures for 26 manual skills. We compared the results with recommendations and data on learning manual skills. Results are presented as mean (standard deviation). Results: Endotracheal intubation via direct laryngoscopy was performed 1032 (739) times by anesthesiologists. Surgeons and internists performed 89 (89) and 77 (65) intubations, respectively. Intubation via video laryngoscopy was performed 79 (81) times by anesthesiologists, 11 (17) times by surgeons and 6 (11) times by internists. Surgeons had little experience in non-invasive ventilation, with 9 (19) performed procedures and had rarely used external pacemaker therapy or electrical cardioversion. In comparison, among all participants non-invasive ventilation was performed 152 (197) times, electrical cardioversion was performed 41 (103) times and an external pacemaker was used 6 (15) times. For other procedures the numbers did not markedly differ between the different specialties. Conclusion: The number of performed procedures markedly differed for some skills between different primary specialties. Recommendations regarding a procedural volume were not always met, suggesting missing expertise for some skills. A defined number of procedures should therefore be a formal requirement to be eligible for board certification in prehospital emergency medicine.

Sensitivity of severe acute respiratory syndrome coronavirus type 2 rapid antigen point-of-care tests in vaccinated patients.

BACKGROUND AND IMPORTANCE: Rapid antigen point-of-care tests (antigen POC tests) are frequently used to detect COVID-19 infections. Based on clinical impressions, we suspected that the sensitivity of antigen POC tests might be lower in vaccinated patients. OBJECTIVE: To evaluate the sensitivity of antigen POC tests in vaccinated patients. DESIGN, SETTING AND PARTICIPANTS: We retrospectively evaluated all patients over 18 years of age that tested positive for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in November 2021 at our institution, whose antigen POC test result had been recorded. We considered patients who were either fully vaccinated or unvaccinated, as well as whether they were symptomatic. OUTCOME MEASURE AND ANALYSIS: We calculated the sensitivity of antigen POC tests in vaccinated and unvaccinated as well as in symptomatic and asymptomatic patients and compared the results. RESULTS: A total of 4080 reverse transcription PCR tests were performed in our institution in November 2021, of which 360 patients tested positive for SARS-CoV-2. Of those, 234 patients met inclusion criteria and were further evaluated. The sensitivity of the antigen POC test was only 39.4% [95% confidence interval (CI), 31.3-48.1%] in vaccinated patients and differed significantly from the sensitivity of 53.3% (95% CI, 43.9-62.4%) in unvaccinated patients (difference of sensitivities, 13.9%; 95% CI, 1.1-26.1%). In symptomatic patients, the sensitivity increased by only 11.8% from 45.7% in all patients (95% CI, 39.5-52.1%) to 57.5% in symptomatic patients (95% CI, 49.9-64.7%). In asymptomatic patients, the antigen POC test was only able to detect SARS-CoV-2 positive patients in 16.4% of the cases (95% CI, 9.4-27.1%). CONCLUSION: Point-of-care antigen tests are likely not useful for ruling out SARS-CoV-2 infection, especially in vaccinated and asymptomatic patients, potentially due to lower viral load. Moreover, the use of these tests might lead to a false sense of security, especially when used by the public as part of a public health testing strategy.