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.
Keywords
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Article info
Publication history
Published online: September 06, 2019
Accepted:
June 22,
2019
Received in revised form:
June 17,
2019
Received:
January 9,
2019
Identification
Copyright
© 2019 Published by Elsevier Inc.
