Prehospital Interventions, Early Detection, and Their Impact on Survival Outcomes in Patients with Sepsis: A Systematic Review

Abstract

Objectives: Sepsis is a life-threatening condition that results in significant morbidity and mortality, particularly when progressing to septic shock. Early detection and treatment, especially before hospital arrival, are crucial for improving outcomes. This review aimed to identify, assess, and summarize studies on the effectiveness of early detection methods and prehospital interventions in enhancing survival rates for patients with sepsis. Methods: This descriptive systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. A comprehensive literature search was conducted across six electronic databases to identify relevant studies published up to November 2024. Studies were screened and independently reviewed by four reviewers, and bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Methodological Index for Non-Randomized Studies tool for observational studies. Results: This review included 23 studies comprising 16,246 patients. Most of the studies were retrospective (57%), with RCTs (22%) and prospective observational studies (13%). Prehospital interventions—including antibiotic therapy (ABT), intravenous fluids, and norepinephrine—were associated with improved outcomes. Antibiotic therapy significantly reduced 30-day mortality. Norepinephrine improved survival, and early intravenous fluid administration lowered hospital mortality. The National Early Warning Score was superior to the quick Sequential Organ Failure Score in screening for sepsis (area under the receiver operating characteristic curve, 0.74 vs. 0.68). Emergency medical services (EMS) tools enhanced adherence to the 3-h sepsis bundle (80% vs. 44.2%). Conclusions: Early antibiotic administration, fluid resuscitation, and hemodynamic stabilization reduce mortality rates and improve clinical outcomes. Validated sepsis screening tools exhibit predictive utility and may support EMS protocols for earlier recognition, though evidence linking their use to improved outcomes remains limited.