The new sepsis consensus definitions: the good, the bad and the ugly

Sprung, Charles L.; Schein, Roland M. H.; Balk, R.A.

doi:10.1007/s00134-016-4604-0

Cited by 50 publications

(28 citation statements)

References 19 publications

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“…It should therefore be no surprise that clinicians are worried that the qSOFA criteria seems to identify the patient too late in the course [3, 20], in-fact up to 12 h later than for the SIRS criteria [5]. A recent study from Torsvik et al [21] showed that education of ward staff in the continuation of systematic SIRS and organ failure-triage (SOF-triage) might prevent patients with blood stream infection (BSI) from progressing to life-threatening sepsis.…”

Section: Discussionmentioning

confidence: 99%

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department

Askim

Moser

Gustad

et al. 2017

Scand J Trauma Resusc Emerg Med

214

154

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BackgroundWe aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS).MethodsThe study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients’ electronic records (EPR) and mortality data from the Norwegian population registry.ResultsOf the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert.DiscussionIn order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival.ConclusionIn this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0399-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department

Askim

Moser

Gustad

et al. 2017

Scand J Trauma Resusc Emerg Med

214

154

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“…Therefore, the old definition for sepsis, also as the only definition enforced during the study enrolment, was applied [ 26 , 27 ]. Retrospectively, we also evaluated Quick SOFA for sepsis definition, but limitations were recognized, as also described by Sprung et al [ 30 ], who critically reviewed the new definition for sepsis based on the problems met in early sepsis recognition and in retrospective derivation for the SOFA score [ 30 ]. According to Sprung et al, “the new definitions discard the sepsis spectrum.” Our findings indicate that neutropenic sepsis may be one of the sepsis types that are discarded.…”

Section: Discussionmentioning

confidence: 99%

Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia

et al. 2017

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Objective Elevated levels of a cell surface glycoprotein, soluble cluster of differentiation 14 (sCD14), have been observed in patients with sepsis. Only scarce data are available on sCD14 in hematological patients with chemotherapy-induced febrile neutropenia. The study aim was to investigate sCD14 as an early biomarker in febrile neutropenia after intensive chemotherapy to detect a rapidly deteriorating clinical course early enough to avoid serious infectious complications. Patients and Methods This prospective study included 87 adult hematological patients at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The study endpoints were septic shock, severe sepsis, and positive blood culture findings. sCD14 was analyzed from day 0 to day 2, and its prognostic capacity was compared to that of C-reactive protein and procalcitonin. Results Plasma level of sCD14 predicted the development of septic shock on day 1 (p = 0.001) and day 2 but not the development of severe sepsis or blood culture positivity in hematological patients with chemotherapy-induced febrile neutropenia. Conclusions Soluble CD14 did not predict an overall complicated course at the early stages of febrile neutropenia. However, it was helpful in predicting the progression of the clinical course of neutropenic fever to septic shock.

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“…Future demand for SOFA score calculation in clinical practice may be dependent on policy from the Centers for Medicare and Medicaid Services (CMS), which is still recommending the use of the previous definition of sepsis outlined in the Severe Sepsis or Septic Shock Early Management (SEP-1) bundle because of concerns about increasing cases of missed sepsis under the new definition [16,17,19]. CMS adoption of the new sepsis definition would likely spur a significant increase in the usage of the SOFA score by linking quality metrics and payments.…”

Section: Discussionmentioning

confidence: 99%

Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection

Aakre¹,

Kitson²,

Li³

et al. 2017

JMIR Hum Factors

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BackgroundThe new sepsis definition has increased the need for frequent sequential organ failure assessment (SOFA) score recalculation and the clerical burden of information retrieval makes this score ideal for automated calculation.ObjectiveThe aim of this study was to (1) estimate the clerical workload of manual SOFA score calculation through a time-motion analysis and (2) describe a user-centered design process for an electronic medical record (EMR) integrated, automated SOFA score calculator with subsequent usability evaluation study.MethodsFirst, we performed a time-motion analysis by recording time-to-task-completion for the manual calculation of 35 baseline and 35 current SOFA scores by 14 internal medicine residents over a 2-month period. Next, we used an agile development process to create a user interface for a previously developed automated SOFA score calculator. The final user interface usability was evaluated by clinician end users with the Computer Systems Usability Questionnaire.ResultsThe overall mean (standard deviation, SD) time-to-complete manual SOFA score calculation time was 61.6 s (33). Among the 24% (12/50) usability survey respondents, our user-centered user interface design process resulted in >75% favorability of survey items in the domains of system usability, information quality, and interface quality.ConclusionsEarly stakeholder engagement in our agile design process resulted in a user interface for an automated SOFA score calculator that reduced clinician workload and met clinicians’ needs at the point of care. Emerging interoperable platforms may facilitate dissemination of similarly useful clinical score calculators and decision support algorithms as “apps.” A user-centered design process and usability evaluation should be considered during creation of these tools.

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The new sepsis consensus definitions: the good, the bad and the ugly

Cited by 50 publications

References 19 publications

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality – a prospective study of patients admitted with infection to the emergency department

Soluble CD14 as a Diagnostic and Prognostic Biomarker in Hematological Patients with Febrile Neutropenia

Iterative User Interface Design for Automated Sequential Organ Failure Assessment Score Calculator in Sepsis Detection

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