Performance of illness severity scores to guide disposition of emergency department patients with severe sepsis or septic shock

Abstract

Two-thirds of ED patients with severe sepsis were admitted to the ward, of whom ∼13% clinically deteriorated, resulting in ICU admission and higher mortality. The PIRO score adds little value over clinical judgement in guiding adequate disposition to wards or the ICU.

Predictors of Patients Who Present to the Emergency Department With Sepsis and Progress to Septic Shock Between 4 and 48 Hours of Emergency Department Arrival*

“…Two previous studies showed different transfer rates from inpatient wards to ICU level of care (4,14). These mixed results are likely due to institutional protocols as well as differences in the methodological study approach (4,5). In our study, we found female patients to be at higher risk of developing septic shock within 48 hours when compared with male patients.…”

“…Three previous studies sought to evaluate the unanticipated need for ICU transfer in patients diagnosed with sepsis while in the ED (3)(4)(5). However, although it is important to understand unanticipated ICU transfers, admission rates to the ICU are highly variable and physician and/or institution dependent.…”

“…A significant proportion of those patients may decompensate and progress to septic shock shortly after leaving the ED (3)(4)(5). Understanding the epidemiology of patients who present to the ED with sepsis or severe sepsis and progress to septic shock can help emergency physicians, intensivists, hospitalists, and other providers make appropriate disposition decisions and improve the quality of care provided to these patients.…”

THERM: the Resuscitation Management score. A prognostic tool to identify critically ill patients in the emergency department

“…Those with lower THERM scores (higher risk) should be considered for referral to critical care, similar to the recommendations for inpatients identified at risk by NEWS. The predisposition, infection, response and organ failure (PIRO) score (a sepsis staging system developed for patients admitted to hospital) has recently been found to add little value over ED clinical judgment in guiding admission to the appropriate level of care,19 and it would be useful to compare THERM with emergency physician judgment, in a future study. THERM could also be used for audit and research, to establish case-mix in a particular ED.…”

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

“…[24][25][26] De Groot et al 24 compared the PIRO and MEDS with physician judgment to predict the need for ICU admission. They found that the PIRO did not perform better than physician judgment in predicting disposition from the ED to a ward bed or to the ICU.…”