1565: Red Flag Sepsis Tool or Sofa for Sepsis Screening on the Ward: Searching for the Best Solution

Kopczynska, Maja; Sharif, Ben; Cleaver, Sian; Spencer, Naomi; Kurani, Amit; Lee, Camilla; Webster, Jessica Wagner; Walford, Rebecca; Durie, Carys; Bradley, Matthew John; Sharma, Angelica; Noble, Amy; Edwards, Ross; Howcroft, Robyn; Preston, Hazel; Szakmány, Tamás

doi:10.1097/01.ccm.0000552308.63146.13

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“…A previous study compared the NICE high-risk criteria in adults, with qSOFA, National Early Warning Score, and SIRS for their ability to predict mortality in an ED and ward setting. 35 NICE high-risk criteria achieved a sensitivity of only 58.9% and were not independently associated with an adverse outcome. In the current study, for the primary outcome we found good discriminative ability suggesting NICE high-risk criteria correlate well with risk of CC admission, and the criteria correctly identified all 5 sepsis-related deaths.…”

Section: Nice High-risk Criteriamentioning

confidence: 92%

Accuracy of a Modified qSOFA Score for Predicting Critical Care Admission in Febrile Children

et al. 2020

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BACKGROUND AND OBJECTIVES: The identification of life-threatening infection in febrile children presenting to the emergency department (ED) remains difficult. The quick Sequential Organ Failure Assessment (qSOFA) was only derived for adult populations, implying an urgent need for pediatric scores. We developed and validated a novel, adapted qSOFA score (Liverpool quick Sequential Organ Failure Assessment [LqSOFA]) and compared its performance with qSOFA, Pediatric Early Warning Score (PEWS), and National Institute for Health and Care Excellence (NICE) high-risk criteria in predicting critical care (CC) admission in febrile children presenting to the ED. METHODS: The LqSOFA (range, 0-4) incorporates age-adjusted heart rate, respiratory rate, capillary refill, and consciousness level on the Alert, Voice, Pain, Unresponsive scale. The primary outcome was CC admission within 48 hours of ED presentation, and the secondary outcome was sepsisrelated mortality. LqSOFA, qSOFA, PEWS, and NICE high-risk criteria scores were calculated, and performance characteristics, including area under the receiver operating characteristic curve, were calculated for each score. RESULTS: In the initial (n = 1121) cohort, 47 CC admissions (4.2%) occurred, and in the validation (n = 12 241) cohort, 135 CC admissions (1.1%) occurred, and there were 5 sepsis-related deaths. In the validation cohort, LqSOFA predicted CC admission with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.76 to 0.86), versus qSOFA (0.66; 95% CI, 0.60 to 0.71), PEWS (0.93; 95% CI, 0.90 to 0.95), and NICE high-risk criteria (0.81; 95% CI, 0.78 to 0.85). For predicting CC admission, the LqSOFA outperformed the qSOFA, with a net reclassification index of 10.4% (95% CI, 1.0% to 19.9%). CONCLUSIONS: In this large study, we demonstrate improved performance of the LqSOFA over qSOFA in identifying febrile children at risk for CC admission and sepsis-related mortality. Further validation is required in other settings. WHAT'S KNOWN ON THIS SUBJECT: The quick Sequential Organ Failure Assessment has been shown to more accurately predict mortality or ICU transfer than systemic inflammatory response syndrome or the quick Pediatric Logistic Organ Dysfunction-2 in an emergency department population, but with only moderate prognostic accuracy. WHAT THIS STUDY ADDS: In this retrospective study of .12 000 febrile children, the Liverpool quick Sequential Organ Failure Assessment outperforms the quick Sequential Organ Failure Assessment in predicting critical care admission. Liverpool quick Sequential Organ Failure Assessment is a rapid bedside tool that should undergo implementation testing.

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Section: Nice High-risk Criteriamentioning

confidence: 92%