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

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.

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

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.

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.

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.