Clin Exp Emerg Med.
2019 Mar;6(1):77-83. 10.15441/ceem.17.294.
Quick Sepsis-related Organ Failure Assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: a retrospective review
- Affiliations
-
- 1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea. suhgil@snu.ac.kr
- 2Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
- 3Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- 4Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
- KMID: 2447312
- DOI: http://doi.org/10.15441/ceem.17.294
Abstract
OBJECTIVE
To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.
METHODS
Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar's test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.
RESULTS
Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.
CONCLUSION
The current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.
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