• Ithan D Peltan, Kasra Rahmati, Joseph R Bledsoe, Yukiko Yoneoka, Felicia Alvarez, Matthew Plendl, Peter P Taillac, Scott T Youngquist, Matthew M Samore, Catherine L Hough, and Samuel M Brown.
• Department of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, UT.
• Crit. Care Med. 2025 Feb 12.

ObjectivesEvaluate prediction models designed or used to identify patients with sepsis in the prehospital setting.DesignNested case-control study.SettingFour emergency departments (EDs) in Utah.PatientsAdult nontrauma patient with available prehospital care records who received ED treatment during 2018 after arrival via ambulance.InterventionsNone.Measurements And Main ResultsOf 16,620 patients arriving to a study ED via ambulance, 1,037 (6.2%) met Sepsis-3 criteria in the ED. Complete prehospital care data was available for 434 case patients with sepsis and 434 control patients without sepsis. Model discrimination for the outcome of meeting Sepsis-3 criteria in the ED was quantified using the area under the precision-recall curve (AUPRC), which yields a value equal to outcome prevalence for a noninformative model. Of 21 evaluated prediction models, only the Prehospital Early Sepsis Detection (PRESEP) model (AUPRC, 0.33 [95% CI, 0.27-0.41) outperformed unaided infection assessment by emergency medical services (EMS) personnel (AUPRC, 0.17 [95% CI, 0.13-0.23]) for prehospital prediction of patients who would meet Sepsis-3 criteria in the ED (p < 0.001). PRESEP also outperformed the quick Sequential Organ Failure Assessment score (AUPRC, 0.13 [95% CI, 0.11-0.16]; p < 0.001). Among 28 evaluated dichotomous predictors of ED sepsis, sensitivity ranged from 6% to 91% and positive predictive value 8-100%. PRESEP exhibited modest sensitivity (60%) and positive predictive value (20%).ConclusionsPRESEP was the only evaluated prediction model that demonstrated better discrimination than unaided EMS infection assessment for the identification of ambulance-transported adult patients who met Sepsis-3 criteria in the ED.Copyright © 2025 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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