Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage

Tusgul, Selin; Carron, Pierre‐Nicolas; Yersin, Bertrand; Calandra, Thierry; Dami, Fabrice

doi:10.1186/s13049-017-0449-y

Cited by 119 publications

(110 citation statements)

References 26 publications

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“…However, some recent studies demonstrated contrary results concerning the usefulness of the qSOFA score in patients with trauma, burns, pneumonia, leukaemia, liver cirrhosis and sepsis qSOFA, quick Sequential Organ Failure Assessment; DqSOFA, subtracting the worst value of the qSOFA score from 1 hr after presentation from the qSOFA score at presentation. [11][12][13][14][21][22][23][24][25][26][27]. These controversies are estimated to vary according to the severity of the disease, the timing of the measurement and the measurement method [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

Cho

Chun

Moon

2018

Basic Clin Pharma Tox

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This study aimed to investigate whether the quick Sequential Organ Failure Assessment (qSOFA) score at emergency department (ED) presentation can help improve the risk assessment of glyphosate-surfactant herbicide (GlySH) poisoning complications. A total of 150 patients presenting with acute glyphosate herbicide ingestion were enrolled in this retrospective observational study. The qSOFA scores at presentation, ΔqSOFA (calculated by subtracting the worst qSOFA score from 1 hr after admission from the qSOFA score at presentation), baseline characteristics, clinical courses and outcome were collected and analysed. A total of 41 patients had life-threatening complications (27.3%), and 14 patients died (9.3%). Patients with a qSOFA score of 0 at presentation had a 1.5% incidence rate of complications. As the qSOFA score at presentation increased from 1 to 3, the rate of life-threatening complications significantly increased from 29.6% to 100%. Patients with a ΔqSOFA of 1 had a higher frequency of complications than did patients with a ΔqSOFA of 0. The qSOFA score (OR: 8.39, 95% CI: 3.51-26.67) and ΔqSOFA (OR: 27.60, 95% CI: 3.87-575.67) were associated with the development of life-threatening complications in the multivariate analysis. The qSOFA score showed high sensitivity (97.56%), and the ΔqSOFA score showed high specificity (99.08%). The values of area under the curve were significantly higher in the models using the qSOFA and ΔqSOFA than they were in the models using previously known prognostic factors (p < 0.01). The clinician should pay more attention to patients with high qSOFA scores at presentation or an increase in the qSOFA score 1 hr after admission.

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Section: Discussionmentioning

confidence: 99%

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

Cho

Chun

Moon

2018

Basic Clin Pharma Tox

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“…Selanjutnya, kriteria klinis sepsis berat yaitu kriteria SIRS ditambah satu tanda disfungsi organ atau hipoperfusi yaitu Glasgow Coma Scale (GCS) <15 atau menurun dari baseline, saturasi oksigen < 90% atau tekanan darah sistolik <90 mmHg (Tabel 1). 6,10 Skor qSOFA diusulkan Sepsis 3 Task Force sebagai alat stratifikasi yang lebih spesifik daripada kriteria SIRS untuk kepentingan penilaian disfungsi organ, mengidentifikasi kondisi infeksi yang mengancam nyawa, memulai atau meningkatkan terapi sepsis secara tepat, dan merujuk pasien ke ruang rawat intensif. 3 Skor qSOFA berkisar dari 0 hingga 3, dengan satu poin diberikan untuk masing-masing tanda-tanda klinis berikut: tekanan darah sistolik ≤100 mmHg, frekuensi pernafasan ≥22 kali/mnt, dan perubahan status mental.…”

Section: Perbedaan Kriteria Sirs Dan Skor Qsofaunclassified

Tinjauan Literatur :PERBANDINGAN qSOFA DAN SIRS DALAM MENGIDENTIFIKASI PASIEN DENGAN SEPSIS DAN MEMPREDIKSI MORTALITASNYA: REVIEW ARTIKEL

Sari

2019

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AbstrakSepsis merupakan penyebab utama kondisi sakit kritis dan mortalitas di dunia. Kondisi sepsis membutuhkan identifikasi segera karena penundaan identifikasi sepsis dapat berakibat pada peningkatan angka mortalitas pasien. Review artikel ini bertujuan untuk menganalisis perbandingan qSOFA dan SIRS dalam mengidentifikasi pasien dengan sepsis dan memprediksi mortalitasnya. Artikel didapatkan melalui pencarian menggunakan online database yaitu PubMed dengan menggunakan kata kunci qSOFA, SIRS, sepsis. Hasil pencarian mengidentifikasi hasil yang relevan dengan kata kunci sejumlah 35 artikel, kemudian dipilih 9 artikel untuk dikaji. Hasilnya terdapat satu studi pada 886 pasien yang menyatakan bahwa qSOFA dan SIRS belum optimal dalam mengidentifikasi sepsis. Terdapat dua studi dengan jumlah total 3.542 pasien yang menyatakan bahwa kriteria SIRS lebih baik dalam mengidentifikasi sepsis dan memprediksi mortalitas pasien. Selanjutnya, terdapat enam studi dengan jumlah total 167.172 pasien yang menyatakan keunggulan qSOFA dibandingkan dengan SIRS dalam mengidentifikasi sepsis dan memprediksi mortalitas pasien. Skor qSOFA lebih unggul dari kriteria SIRS dalam mengidentifikasi pasien sepsis dengan disfungsi organ yang berisiko tinggi mengalami kematian, sedangkan kriteria SIRS lebih unggul dari skor qSOFA dalam mengidentifikasi pasien sepsis yang belum mengalami disfungsi organ dan berisiko rendah mengalami kematian. AbstractSepsis is a leading cause of critical illness and mortality in the world. Sepsis condition requires early identification because late identification of sepsis may lead to an increase in patient mortality. The purpose of this article review was to compare the ability of qSOFA and SIRS for identifying patients with sepsis and predicting its mortalities. Studies reporting on qSOFA and SIRS were searched using PubMed by using keywords qSOFA, SIRS, sepsis. The search results identified 35 relevant articles, then 9 articles were selected for review. The results showed one study with 886 patients reported that both of qSOFA and SIRS were not optimal in identifying sepsis. Two studies with a total of 3.542 patients reported that SIRS criteria were better in identifying sepsis and predicting mortality. Six studies with a total of 167.172 patients reported the superiority of qSOFA compared to SIRS in identifying sepsis and predicting mortality. The qSOFA score is superior compared to SIRS criteria in identifying sepsis patients with organ dysfunction who were at high risk of mortality, while the SIRS criteria are superior compared to qSOFA score in identifying sepsis patients without organ dysfunction who were at low risk of mortality.

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“…In this meta-analysis, 35 studies with 269,544 patients reported on the prognostic accuracy of the qSOFA and short-term mortality, including 27 retrospective studies [5][6][7][8]10,11,[13][14][15][16]18,20,22,[24][25][26][27]29,[32][33][34][35][37][38][39][40] , while 8 studies were prospective studies 9,12,17,19,21,23,28,30,36 . Due to the heterogeneity of the inclusion criteria, a random-effects model was used to calculate the pooled sensitivity and specificity of the included studies.…”

Section: The Qsofa and Short-term Mortalitymentioning

confidence: 99%

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Tan

Tang

Ching

et al. 2018

Preprint

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ObjectiveIn year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS).The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short-and long-term mortality among patients outside the intensive care unit setting. MethodStudies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15 th December 2017) and SCOPUS (published before 15 th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and DiscussionA total of 39 studies met the selection criteria for full text review and only 36 studies were included. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I 2 =94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I 2 <0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. ConclusionqSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.

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Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage

Cited by 119 publications

References 26 publications

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

Tinjauan Literatur :PERBANDINGAN qSOFA DAN SIRS DALAM MENGIDENTIFIKASI PASIEN DENGAN SEPSIS DAN MEMPREDIKSI MORTALITASNYA: REVIEW ARTIKEL

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

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