Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score
2019
textabstractObjective
In hospitalized patients, the risk of sepsis-related mortality can be assessed using the quick
Sepsis-related Organ Failure Assessment (qSOFA). Currently, different tools that predict
deterioration such as the National Early Warning Score (NEWS) have been introduced in
clinical practice in Emergency Departments (ED) worldwide. It remains ambiguous which
screening tool for mortality at the ED is best. The objective of this study was to evaluate the
predictive performance for mortality of two sepsis-based scores (i.e. qSOFA and Systemic
Inflammatory Response Syndrome (SIRS)-criteria) compared to the more general NEWS
score, in patients with suspected infection directly at presentation to the ED.
Methods
We performed a retrospective cohort study. Patients who presented to the ED between
June 2012 and May 2016 with suspected sepsis in a large tertiary care center were included.
Suspected sepsis was defined as initiation of intravenous antibiotics and/or collection of any
culture in the ED. Outcome was defined as 10-day and 30-day mortality after ED presentation. Predictive performance was expressed as discrimination (AUC) and calibration using
Hosmer-Lemeshow goodness-of-fit test. Subsequently, sensitivity, and specificity were
calculated.
Results
In total 8,204 patients were included of whom 286 (3.5%) died within ten days and 490
(6.0%) within 30 days after presentation. NEWS had the best performance, followed by qSOFA and SIRS (10-day AUC: 0.837, 0.744, 0.646, 30-day AUC: 0.779, 0.697, 0.631).
qSOFA (�2) lacked a high sensitivity versus SIRS (�2) and NEWS (�7) (28.5%, 77.2%,
68.0%), whilst entailing highest specificity versus NEWS and SIRS (93.7%, 66.5%, 37.6%).
Conclusions
NEWS is more accurate in predicting 10- and 30-day mortality than qSOFA and SIRS in
patients presenting to the ED with suspected sepsis.
Keywords:
- Correction
- Source
- Cite
- Save
- Machine Reading By IdeaReader
31
References
40
Citations
NaN
KQI