Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score

Abstract

ObjectiveIn 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.MethodsWe 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.ResultsIn 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%).ConclusionsNEWS is more accurate in predicting 10- and 30-day mortality than qSOFA and SIRS in patients presenting to the ED with suspected sepsis.

Identifying adults with sepsis, bedside tools versus administrative data: a cohort study

“…11 Our findings are consistent with the broader literature demonstrating superior performance of NEWS over qSOFA and SIRS in predicting mortality. 13,23,24,25 Although other studies have reported SOFA as being superior to NEWS in predicting mortality, 14,26 this was not replicated in our data. Indeed, SOFA had poorer performance characteristics in our cohort than reported in other retrospective studies.…”

The Utility of the Rapid Emergency Medicine Score (REMS) compared with SIRS, qSOFA and NEWS for predicting in-Hospital Mortality Among Patients with Suspicion of Sepsis in an Emergency Department

“…NEWS is a widely used to identify clinically-deteriorating patients, and it has been proven to have better accuracy both in wards and in the ED. [15][16][17][18] Similar to previous studies, 15,16 we found that NEWS without baseline risk model could outperform SIRS and qSOFA in AUROC. It also showed higher NB than qSOFA and SIRS over a narrow range of threshold probability.…”

“…This could be evidenced by the much lower validation AUROCs in our study compared to other studies from higher-income countries, which shows poor transportability of their ndings to our setting. [15][16][17][18][19] Moreover, the length of hospital stay range was as much as 310 days and the median time to mortality in our cohort was 27 days (data not shown), indicating prolonged hospital length of stay that may have been due to the lack of hospice service provision in Thailand. Therefore, our mortality within 7 days of admission outcome may be a more valid outcome de nition for sepsis-related mortality in our setting and other similar settings.…”

Comparison of Monocyte Distribution Width (MDW) and Procalcitonin for early recognition of sepsis

“…Outside of the intensive care units, as in the ED or in lower intensity wards, early diagnosis and rapid treatment initiation are even more crucial for halting progression of disease and poor patient prognosis [1,2,33]. The qSOFA and NEWS (National Early Warning Score) scores have been proposed and frequently implemented as a tool to frequently screen patients with infection at risk of organ dysfunction and death [34][35][36][37], as widespread and frequent monitoring of biomarkers as PCT may be impractical or too expensive in these settings. Haydar et al (2017) reported the qSOFA score was efficacious for the identification of patients with sepsis at increased risk of mortality, while performing poorly as a screening tool for early identification of sepsis in the emergency department [33].…”