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

Autor: Helga Stene, Lars Petter Bjørnsen, Jostein Dale, Maren Gundersen, Åsa Susanne Askim, Florentin Moser, Jan Kristian Damås, Lise Tuset Gustad, Erik Solligård, Bjørn Olav Åsvold
Rok vydání: 2017
Předmět:
Male
Urban Population
Critical Care and Intensive Care Medicine
Severity of Illness Index
Hospitals
University
0302 clinical medicine
Mass Screening
Hospital Mortality
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Original Research
Aged
80 and over
education.field_of_study
Norway
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Middle Aged
Prognosis
Systemic Inflammatory Response Syndrome
Hospitalization
Prospective
Emergency Medicine
Female
Emergency Service
Hospital
quick-SOFA (q-sofa)
Cohort study
Adult
medicine.medical_specialty
Population
Emergency Department (ED)
Infections
Risk Assessment
Sepsis
03 medical and health sciences
medicine
Humans
Rapid emergency triage and treatment system (RETTS)
education
Mass screening
Aged
Systemic inflammatory response syndrome (SIRS)
business.industry
030208 emergency & critical care medicine
lcsh:RC86-88.9
Emergency department
medicine.disease
Triage
Systemic inflammatory response syndrome
Emergency medicine
business
Zdroj: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 25, Iss 1, Pp 1-9 (2017)
ISSN: 1757-7241
Popis: Background We 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). Methods The 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. Results Of 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. Discussion In 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. Conclusion In 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 material The online version of this article (doi:10.1186/s13049-017-0399-4) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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