Clinical Scores and Formal Triage for Screening of Sepsis and Adverse Outcomes on Arrival in an Emergency Department All-Comer Cohort
type: Article
item type: journalArticle
is part of: J Emerg Med
authors: Person
  surname: Nieves Ortega
  given name: R.
authors: Person
  surname: Rosin
  given name: C.
authors: Person
  surname: Bingisser
  given name: R.
authors: Person
  surname: Nickel
  given name: C. H.
subject: Adolescent
subject: Adult
subject: Aged
subject: Aged, 80 and over
subject: Area Under Curve
subject: Child
subject: Cohort Studies
subject: Emergency Service, Hospital/organization & administration/standards/statistics &
subject: Esi
subject: Female
subject: Hospital Mortality
subject: Hospitalization/statistics & numerical data
subject: Humans
subject: Male
subject: Mass Screening/methods/*standards/statistics & numerical data
subject: Middle Aged
subject: News
subject: Organ Dysfunction Scores
subject: Prognosis
subject: ROC Curve
subject: Retrospective Studies
subject: Sepsis/*classification/diagnosis
subject: Sirs
subject: Sofa
subject: Treatment Outcome
subject: Triage
subject: numerical data
subject: qSOFA
subject: screening
subject: sepsis
abstract: BACKGROUND: Early recognition of sepsis remains a major challenge. The clinical utility of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) score is still undefined. Several studies have tested its prognostic value. However, its ability to diagnose sepsis is still unknown. OBJECTIVE: Our aim was to compare the performance of qSOFA, systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), and formal triage with the Emergency Severity Index (ESI) algorithm to identify patients with sepsis and predict adverse outcomes on arrival in an emergency department (ED) all-comer cohort. METHODS: We included all patients presenting consecutively to the ED during a 3-week period. We used vital signs recorded at triage to calculate the study scores. Two independent assessors retrospectively assigned the primary outcome of sepsis according to Third International Consensus Definitions for Sepsis and Septic Shock criteria in a chart review process. RESULTS: There were 2523 cases included in the analysis and 39 (1.6%) had the primary outcome of sepsis. The area under the curve for sepsis was 0.79 (95% confidence interval [CI] 0.71-0.86) for qSOFA, 0.81 (95% CI 0.73-0.87) for SIRS, 0.85 (95% CI 0.77-0.92) for NEWS, and 0.77 (95% CI 0.70-0.83) for ESI. CONCLUSIONS: qSOFA offered high specificity for the prediction of sepsis and adverse outcomes. However, its low sensitivity does not support widespread use as a screening tool for sepsis. NEWS outperformed qSOFA for prediction of adverse outcomes and screening for sepsis.
date: 2019-09-11
pages: 453-460 e2
coverage: 31500993

J Emerg Med
type: Journal
volume: 57
number: 4
identifier: DOI 10.1016/j.jemermed.2019.06.036
identifier: ISSN 0736-4679 (Print) 0736-4679 (Linking)