Dispatch suspicion of sepsis and time from emergency department arrival to antibiotic administration: a Norwegian registry study

Background Early recognition of symptoms compatible with sepsis is essential for timely hospital admission and treatment. Evidence on how suspicion of sepsis by the emergency medical dispatch centre (EMDC) impacts subsequent care is limited. We aimed to examine the association between EMDC suspicion of sepsis and time to antibiotic administration following hospital admission. Methods We conducted a retrospective registry-based study of adults (≥ 18 years) with sepsis admitted to Stavanger University Hospital between January 1, 2022, and December 31, 2023. Prehospital and hospital records were linked using national identity numbers. Sepsis was defined by ICD-10 codes A40–A41 as the primary diagnosis, or R65.0, R65.1, or R57.2 as a secondary diagnosis, recorded at emergency department admission. Patients were categorised according to EMDC-assigned ambulance dispatch category, with Norwegian Index for Medical Emergencies criterion 16 indicating suspected sepsis and compared with patients assigned a non-sepsis dispatch criterion. The primary outcome was time from emergency department (ED) arrival to antibiotic administration. Secondary outcomes were the proportions of patients receiving antibiotics within 60 and 120 min of ED arrival. Data were analysed using linear and logistic regression adjusted for age, sex, ED triage priority, and the ED Triage Early Warning Score. Results Of 527 sepsis admissions, 371 (70%) involved EMDC contact. Of these, 115 underwent symptom-based triage, and 31/115 (27%) were classified as suspected sepsis. In this cohort, suspicion of sepsis at dispatch was associated with a 31-minute shorter adjusted time to antibiotic administration (95% CI − 59.9 to − 1.8 min; p = 0.038) and threefold higher odds of administration within 60 min (adjusted OR 3.09; 95% CI 1.14–8.63). No significant association was observed for administration within 120 min (adjusted OR 1.62; 95% CI 0.58–4.95). Conclusion Sepsis was suspected at dispatch in only a minority of patients subsequently diagnosed with sepsis. When suspicion was raised, it was associated with reduced time to antibiotic administration. Whether improved suspicion at dispatch translates into better sepsis care warrants prospective evaluation.