Clinical Scores and Formal Triage for Screening of Sepsis and Adverse Outcomes on Arrival in an Emergency Department All-Comer Cohort
| Autor: | Roland Bingisser, Ricardo Nieves Ortega, Christian H. Nickel, Christiane Rosin |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Organ Dysfunction Scores Sepsis Cohort Studies 03 medical and health sciences 0302 clinical medicine Medicine Humans Mass Screening 030212 general & internal medicine Hospital Mortality Child Aged Retrospective Studies Aged 80 and over business.industry Septic shock 030208 emergency & critical care medicine Emergency department Middle Aged medicine.disease Early warning score Prognosis Triage Emergency Severity Index Systemic inflammatory response syndrome Hospitalization Treatment Outcome ROC Curve Area Under Curve Emergency medicine Emergency Medicine Female business Emergency Service Hospital Cohort study |
| Zdroj: | The Journal of emergency medicine. 57(4) |
| ISSN: | 0736-4679 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect