Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit
The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU). We sought to compare qSOFA with other commonly used early warning scores. All admitted patients who first met the criteria for...
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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2017-04, Vol.195 (7), p.906-911 |
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| creator | Churpek, Matthew M Snyder, Ashley Han, Xuan Sokol, Sarah Pettit, Natasha Howell, Michael D Edelson, Dana P |
| description | The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU).
We sought to compare qSOFA with other commonly used early warning scores.
All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included. The qSOFA, Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS) were compared for predicting death and ICU transfer.
Of the 30,677 included patients, 1,649 (5.4%) died and 7,385 (24%) experienced the composite outcome (death or ICU transfer). Sixty percent (n = 18,523) first met the suspicion criteria in the ED. Discrimination for in-hospital mortality was highest for NEWS (area under the curve [AUC], 0.77; 95% confidence interval [CI], 0.76-0.79), followed by MEWS (AUC, 0.73; 95% CI, 0.71-0.74), qSOFA (AUC, 0.69; 95% CI, 0.67-0.70), and SIRS (AUC, 0.65; 95% CI, 0.63-0.66) (P |
| doi_str_mv | 10.1164/rccm.201604-0854OC |
| format | Article |
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We sought to compare qSOFA with other commonly used early warning scores.
All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included. The qSOFA, Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS) were compared for predicting death and ICU transfer.
Of the 30,677 included patients, 1,649 (5.4%) died and 7,385 (24%) experienced the composite outcome (death or ICU transfer). Sixty percent (n = 18,523) first met the suspicion criteria in the ED. Discrimination for in-hospital mortality was highest for NEWS (area under the curve [AUC], 0.77; 95% confidence interval [CI], 0.76-0.79), followed by MEWS (AUC, 0.73; 95% CI, 0.71-0.74), qSOFA (AUC, 0.69; 95% CI, 0.67-0.70), and SIRS (AUC, 0.65; 95% CI, 0.63-0.66) (P < 0.01 for all pairwise comparisons). Using the highest non-ICU score of patients, ≥2 SIRS had a sensitivity of 91% and specificity of 13% for the composite outcome compared with 54% and 67% for qSOFA ≥2, 59% and 70% for MEWS ≥5, and 67% and 66% for NEWS ≥8, respectively. Most patients met ≥2 SIRS criteria 17 hours before the combined outcome compared with 5 hours for ≥2 and 17 hours for ≥1 qSOFA criteria.
Commonly used early warning scores are more accurate than the qSOFA score for predicting death and ICU transfer in non-ICU patients. These results suggest that the qSOFA score should not replace general early warning scores when risk-stratifying patients with suspected infection.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201604-0854OC</identifier><identifier>PMID: 27649072</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Organ Dysfunction Scores ; Original ; Reproducibility of Results ; Risk Assessment ; ROC Curve ; Sensitivity and Specificity ; Sepsis - complications ; Sepsis - diagnosis ; Systemic Inflammatory Response Syndrome - complications ; Systemic Inflammatory Response Syndrome - diagnosis</subject><ispartof>American journal of respiratory and critical care medicine, 2017-04, Vol.195 (7), p.906-911</ispartof><rights>Copyright American Thoracic Society Apr 1, 2017</rights><rights>Copyright © 2017 by the American Thoracic Society 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c426t-4fc06bdc7d0b2437182d0cbabe4f0ebb7613211605bc1085bbbe26ecbe87b9083</citedby><cites>FETCH-LOGICAL-c426t-4fc06bdc7d0b2437182d0cbabe4f0ebb7613211605bc1085bbbe26ecbe87b9083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,4011,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27649072$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Churpek, Matthew M</creatorcontrib><creatorcontrib>Snyder, Ashley</creatorcontrib><creatorcontrib>Han, Xuan</creatorcontrib><creatorcontrib>Sokol, Sarah</creatorcontrib><creatorcontrib>Pettit, Natasha</creatorcontrib><creatorcontrib>Howell, Michael D</creatorcontrib><creatorcontrib>Edelson, Dana P</creatorcontrib><title>Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU).
We sought to compare qSOFA with other commonly used early warning scores.
All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included. The qSOFA, Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS) were compared for predicting death and ICU transfer.
Of the 30,677 included patients, 1,649 (5.4%) died and 7,385 (24%) experienced the composite outcome (death or ICU transfer). Sixty percent (n = 18,523) first met the suspicion criteria in the ED. Discrimination for in-hospital mortality was highest for NEWS (area under the curve [AUC], 0.77; 95% confidence interval [CI], 0.76-0.79), followed by MEWS (AUC, 0.73; 95% CI, 0.71-0.74), qSOFA (AUC, 0.69; 95% CI, 0.67-0.70), and SIRS (AUC, 0.65; 95% CI, 0.63-0.66) (P < 0.01 for all pairwise comparisons). Using the highest non-ICU score of patients, ≥2 SIRS had a sensitivity of 91% and specificity of 13% for the composite outcome compared with 54% and 67% for qSOFA ≥2, 59% and 70% for MEWS ≥5, and 67% and 66% for NEWS ≥8, respectively. Most patients met ≥2 SIRS criteria 17 hours before the combined outcome compared with 5 hours for ≥2 and 17 hours for ≥1 qSOFA criteria.
Commonly used early warning scores are more accurate than the qSOFA score for predicting death and ICU transfer in non-ICU patients. These results suggest that the qSOFA score should not replace general early warning scores when risk-stratifying patients with suspected infection.</description><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Organ Dysfunction Scores</subject><subject>Original</subject><subject>Reproducibility of Results</subject><subject>Risk Assessment</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis - complications</subject><subject>Sepsis - diagnosis</subject><subject>Systemic Inflammatory Response Syndrome - complications</subject><subject>Systemic Inflammatory Response Syndrome - diagnosis</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdUsFu1DAQjRCIlsIPcECWuHBoip04sfeCVIUWKlVaYKngZtnOZOuS2FuPU2l_ka_Cy5YKONl6783Mm9EripeMnjDW8rfR2umkoqylvKSy4cvuUXHImrop-ULQx_lPRV1yvvh-UDxDvKGUVZLRp8VBJVq-oKI6LH5-np39QVawQYdlhFEn6MkyrrUn59qNcwRyigiIE_h0TFZbTDA5Sy78MOpp0inELfkCuAkeIdO-j2GCY6J9T850HLfkm47e-TVZ2RAByRAieQ8JbNqB3ei8s3r8DUUXok4ueOL8bkDWZDOfMpRnIwlzQtcDSdeQ2QQe3R2QTmeLV96l58WTQY8IL-7fo-Lq_Oxr97G8XH646E4vS8urNpV8sLQ1vRU9NRWvBZNVT63RBvhAwRjRsrrK96WNsSyf1RgDVQvWgBRmQWV9VLzb993MZoLeZm9Rj2oT3aTjVgXt1L-Md9dqHe5UU0shaJMbvLlvEMPtDJjU5NDCOGoPYUbFZN1wzhhts_T1f9KbMEef18sqyYUUUrKsqvYqGwNihOHBDKNqFxW1i4raR0Xto5KLXv29xkPJn2zUvwATpcEI</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Churpek, Matthew M</creator><creator>Snyder, Ashley</creator><creator>Han, Xuan</creator><creator>Sokol, Sarah</creator><creator>Pettit, Natasha</creator><creator>Howell, Michael D</creator><creator>Edelson, Dana P</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170401</creationdate><title>Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit</title><author>Churpek, Matthew M ; Snyder, Ashley ; Han, Xuan ; Sokol, Sarah ; Pettit, Natasha ; Howell, Michael D ; Edelson, Dana P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-4fc06bdc7d0b2437182d0cbabe4f0ebb7613211605bc1085bbbe26ecbe87b9083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Emergency Service, Hospital</topic><topic>Female</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Organ Dysfunction Scores</topic><topic>Original</topic><topic>Reproducibility of Results</topic><topic>Risk Assessment</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Sepsis - complications</topic><topic>Sepsis - diagnosis</topic><topic>Systemic Inflammatory Response Syndrome - complications</topic><topic>Systemic Inflammatory Response Syndrome - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Churpek, Matthew M</creatorcontrib><creatorcontrib>Snyder, Ashley</creatorcontrib><creatorcontrib>Han, Xuan</creatorcontrib><creatorcontrib>Sokol, Sarah</creatorcontrib><creatorcontrib>Pettit, Natasha</creatorcontrib><creatorcontrib>Howell, Michael D</creatorcontrib><creatorcontrib>Edelson, Dana P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of respiratory and critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Churpek, Matthew M</au><au>Snyder, Ashley</au><au>Han, Xuan</au><au>Sokol, Sarah</au><au>Pettit, Natasha</au><au>Howell, Michael D</au><au>Edelson, Dana P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit</atitle><jtitle>American journal of respiratory and critical care medicine</jtitle><addtitle>Am J Respir Crit Care Med</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>195</volume><issue>7</issue><spage>906</spage><epage>911</epage><pages>906-911</pages><issn>1073-449X</issn><eissn>1535-4970</eissn><abstract>The 2016 definitions of sepsis included the quick Sepsis-related Organ Failure Assessment (qSOFA) score to identify high-risk patients outside the intensive care unit (ICU).
We sought to compare qSOFA with other commonly used early warning scores.
All admitted patients who first met the criteria for suspicion of infection in the emergency department (ED) or hospital wards from November 2008 until January 2016 were included. The qSOFA, Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS) were compared for predicting death and ICU transfer.
Of the 30,677 included patients, 1,649 (5.4%) died and 7,385 (24%) experienced the composite outcome (death or ICU transfer). Sixty percent (n = 18,523) first met the suspicion criteria in the ED. Discrimination for in-hospital mortality was highest for NEWS (area under the curve [AUC], 0.77; 95% confidence interval [CI], 0.76-0.79), followed by MEWS (AUC, 0.73; 95% CI, 0.71-0.74), qSOFA (AUC, 0.69; 95% CI, 0.67-0.70), and SIRS (AUC, 0.65; 95% CI, 0.63-0.66) (P < 0.01 for all pairwise comparisons). Using the highest non-ICU score of patients, ≥2 SIRS had a sensitivity of 91% and specificity of 13% for the composite outcome compared with 54% and 67% for qSOFA ≥2, 59% and 70% for MEWS ≥5, and 67% and 66% for NEWS ≥8, respectively. Most patients met ≥2 SIRS criteria 17 hours before the combined outcome compared with 5 hours for ≥2 and 17 hours for ≥1 qSOFA criteria.
Commonly used early warning scores are more accurate than the qSOFA score for predicting death and ICU transfer in non-ICU patients. These results suggest that the qSOFA score should not replace general early warning scores when risk-stratifying patients with suspected infection.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>27649072</pmid><doi>10.1164/rccm.201604-0854OC</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1073-449X |
| ispartof | American journal of respiratory and critical care medicine, 2017-04, Vol.195 (7), p.906-911 |
| issn | 1073-449X 1535-4970 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Emergency Service, Hospital Female Hospitalization Humans Male Middle Aged Organ Dysfunction Scores Original Reproducibility of Results Risk Assessment ROC Curve Sensitivity and Specificity Sepsis - complications Sepsis - diagnosis Systemic Inflammatory Response Syndrome - complications Systemic Inflammatory Response Syndrome - diagnosis |
| title | Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit |
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