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Martín-Rodríguez F, Enriquez de Salamanca Gambara R, Sanz-García A, Castro Villamor MA, Del Pozo Vegas C, Sánchez Soberón I, Delgado Benito JF, Martín-Conty JL, López-Izquierdo R. Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study. Eur J Emerg Med 2023; 30:193-201. [PMID: 37040664 DOI: 10.1097/mej.0000000000001019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
The long-term predictive validity of early warning scores (EWS) has not been fully elucidated yet. The aim of the present study is to compare seven prehospital EWS to predict 1-year mortality. A prospective, multicenter, ambulance-based study of adult patients with an acute illness involving six advanced life support units and 38 basic life support units, referring to five emergency departments in Spain. The primary outcome was long-term mortality with a 1-year follow-up. The compared scores included: National Early Warning Score 2, VitalPAC early warning score, modified rapid emergency medicine score (MREMS), Sepsis-related Organ Failure Assessment, Cardiac Arrest Risk Triage Score, Rapid Acute Physiology Score, and Triage Early Warning Score. Discriminative power [area under the receiver operating characteristic curve (AUC)] and decision curve analysis (DCA) were used to compare the scores. Additionally, a Cox regression and Kaplan-Meier method were used. Between 8 October 2019, and 31 July 2021, a total of 2674 patients were selected. The MREMS presented the highest AUC of 0.77 (95% confidence interval, 0.75-0.79), significantly higher than those of the other EWS. It also exhibited the best performance in the DCA and the highest hazard ratio for 1-year mortality [3.56 (2.94-4.31) for MREMS between 9 and 18 points, and 11.71 (7.21-19.02) for MREMS > 18]. Among seven tested EWS, the use of the MREMS presented better characteristics to predict 1-year mortality; however, all these scores present moderate performances.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid
- Advanced Life Support, Emergency Medical Services (SACYL)
- Prehospital Early Warning Scoring-System Investigation Group
| | | | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina
| | - Miguel A Castro Villamor
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid
- Prehospital Early Warning Scoring-System Investigation Group
| | - Carlos Del Pozo Vegas
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid
- Prehospital Early Warning Scoring-System Investigation Group
- Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | - Juan F Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL)
- Prehospital Early Warning Scoring-System Investigation Group
| | - José L Martín-Conty
- Nursing, Physiotherapy and Occupational Therapy, Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina
| | - Raúl López-Izquierdo
- Advanced Clinical Simulation Center, Faculty of Medicine, Universidad de Valladolid
- Prehospital Early Warning Scoring-System Investigation Group
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid
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The prognostic utility of prehospital qSOFA in addition to emergency department qSOFA for sepsis in patients with suspected infection: A retrospective cohort study. PLoS One 2023; 18:e0282148. [PMID: 36827234 PMCID: PMC9956063 DOI: 10.1371/journal.pone.0282148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The quick sequential organ failure assessment (qSOFA) was widely used to estimate the risks of sepsis in patients with suspected infection in the prehospital and emergency department (ED) settings. Due to the insufficient sensitivity of qSOFA on arrival at the ED (ED qSOFA), the Surviving Sepsis Campaign 2021 recommended against using qSOFA as a single screening tool for sepsis. However, it remains unclear whether the combined use of prehospital and ED qSOFA improves its sensitivity for identifying patients at a higher risk of sepsis at the ED. METHODS We retrospectively analyzed the data from the ED of a tertiary medical center in Japan from April 2018 through March 2021. Among all adult patients (aged ≥18 years) transported by ambulance to the ED with suspected infection, we identified patients who were subsequently diagnosed with sepsis based on the Sepsis-3 criteria. We compared the predictive abilities of prehospital qSOFA, ED qSOFA, and the sum of prehospital and ED qSOFA (combined qSOFA) for sepsis in patients with suspected infection at the ED. RESULTS Among 2,407 patients with suspected infection transported to the ED by ambulance, 369 (15%) patients were subsequently diagnosed with sepsis, and 217 (9%) died during hospitalization. The sensitivity of prehospital qSOFA ≥2 and ED qSOFA ≥2 were comparable (c-statistics for sepsis [95%CI], 0.57 [0.52-0.62] vs. 0.55 [0.50-0.60]). However, combined qSOFA (cutoff, ≥3 [max 6]) was more sensitive than ED qSOFA (cutoff, ≥2) for identifying sepsis (0.67 [95%CI, 0.62-0.72] vs. 0.55 [95%CI, 0.50-0.60]). Using combined qSOFA, we identified 44 (12%) out of 369 patients who were subsequently diagnosed with sepsis, which would have been missed using ED qSOFA alone. CONCLUSIONS Using both prehospital and ED qSOFA could improve the screening ability of sepsis among patients with suspected infection at the ED.
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Melero-Guijarro L, Sanz-García A, Martín-Rodríguez F, Lipari V, Mazas Perez Oleaga C, Carvajal Altamiranda S, Martínez López NM, Domínguez Azpíroz I, Castro Villamor MA, Sánchez Soberón I, López-Izquierdo R. Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study. Front Med (Lausanne) 2023; 10:1149736. [PMID: 37144037 PMCID: PMC10151818 DOI: 10.3389/fmed.2023.1149736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Nowadays, there is no gold standard score for prehospital sepsis and sepsis-related mortality identification. The aim of the present study was to analyze the performance of qSOFA, NEWS2 and mSOFA as sepsis predictors in patients with infection-suspected in prehospital care. The second objective is to study the predictive ability of the aforementioned scores in septic-shock and in-hospital mortality. Methods Prospective, ambulance-based, and multicenter cohort study, developed by the emergency medical services, among patients (n = 535) with suspected infection transferred by ambulance with high-priority to the emergency department (ED). The study enrolled 40 ambulances and 4 ED in Spain between 1 January 2020, and 30 September 2021. All the variables used in the scores, in addition to socio-demographic data, standard vital signs, prehospital analytical parameters (glucose, lactate, and creatinine) were collected. For the evaluation of the scores, the discriminative power, calibration curve and decision curve analysis (DCA) were used. Results The mSOFA outperformed the other two scores for mortality, presenting the following AUCs: 0.877 (95%CI 0.841-0.913), 0.761 (95%CI 0.706-0.816), 0.731 (95%CI 0.674-0.788), for mSOFA, NEWS, and qSOFA, respectively. No differences were found for sepsis nor septic shock, but mSOFA's AUCs was higher than the one of the other two scores. The calibration curve and DCA presented similar results. Conclusion The use of mSOFA could provide and extra insight regarding the short-term mortality and sepsis diagnostic, backing its recommendation in the prehospital scenario.
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Affiliation(s)
- Laura Melero-Guijarro
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- *Correspondence: Ancor Sanz-García,
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - Vivian Lipari
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Cristina Mazas Perez Oleaga
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Arecibo, PR, United States
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
| | - Stefanía Carvajal Altamiranda
- Universidad Europea del Atlántico, Santader, Spain
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Nohora Milena Martínez López
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Irma Domínguez Azpíroz
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Universidad de La Romana, La Romana, Dominican Republic
| | - Miguel A. Castro Villamor
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
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Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality. DISEASE MARKERS 2022; 2022:5351137. [PMID: 35242244 PMCID: PMC8886755 DOI: 10.1155/2022/5351137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/18/2022]
Abstract
Background. The aim of this study was to assess the role of prehospital point-of-care N-terminal probrain natriuretic peptide to predict sepsis, septic shock, or in-hospital sepsis-related mortality. Methods. A prospective, emergency medical service-delivered, prognostic, cohort study of adults evacuated by ambulance and admitted to emergency department between January 2020 and May 2021. The discriminative power of the predictive variable was assessed through a prediction model trained using the derivation cohort and evaluated by the area under the curve of the receiver operating characteristic on the validation cohort. Results. A total of 1,360 patients were enrolled with medical disease in the study. The occurrence of sepsis, septic shock, and in-hospital sepsis-related mortality was 6.4% (67 cases), 4.2% (44 cases), and 6.1% (64 cases). Prehospital National Early Warning Score 2 had superior predictive validity than quick Sequential Organ Failure Assessment and N-terminal probrain natriuretic peptide for detecting sepsis and septic shock, but N-terminal probrain natriuretic peptide outperformed both scores in in-hospital sepsis-related mortality estimation. Application of N-terminal probrain natriuretic peptide to subgroups of the other two scores improved the identification of sepsis, septic shock, and sepsis-related mortality in the group of patients with low-risk scoring. Conclusions. The incorporation of N-terminal probrain natriuretic peptide in prehospital care combined with already existing scores could improve the identification of sepsis, septic shock, and sepsis-related mortality.
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