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De Silva M, Chadwick W, Naidoo N. Screening tools for sepsis identification in paramedicine and other emergency contexts: a rapid systematic review. Scand J Trauma Resusc Emerg Med 2023; 31:74. [PMID: 37946312 PMCID: PMC10634129 DOI: 10.1186/s13049-023-01111-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/14/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Sepsis is a life-threatening condition that contributes significantly to protracted hospitalisations globally. The unique positioning of paramedics and other emergency care cadres in emergency contexts enable the prospect of early identification and management of sepsis, however, a standardised screening tool still does not exist in the emergency setting. The objective of this review was to identify and recommend the most clinically ideal sepsis screening tool for emergency contexts such as emergency departments and out-of-hospital emergency contexts. METHODS A rapid review of five databases (Medline, Embase, the Cochrane Library, CINAHL, and ProQuest Central) was undertaken, with searches performed on February 10, 2022. Covidence software was used by two authors for initial screening, and full text review was undertaken independently by each reviewer, with conflicts resolved by consensus-finding and a mediator. Systematic reviews, meta-analyses, randomised controlled trials, and prospective observational studies were eligible for inclusion. Data extraction used an a priori template and focused on sensitivity and specificity, with ROBINS-I and ROBIS bias assessment tools employed to assess risk of bias in included studies. Study details and key findings were summarised in tables. The a priori review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/3XQ5T ). RESULTS The literature search identified 362 results. After review, 18 studies met the inclusion criteria and were included for analysis. There were five systematic reviews, with three including meta-analysis, eleven prospective observational studies, one randomised controlled trial, and one validation study. CONCLUSIONS The review recognised that a paucity of evidence exists surrounding standardised sepsis screening tools in the emergency context. The use of a sepsis screening tool in the emergency environment may be prudent, however there is currently insufficient evidence to recommend a single screening tool for this context. A combination of the qSOFA and SIRS may be employed to avoid 'practice paralysis' in the interim. The authors acknowledge the inherent potential for publication and selection bias within the review due to the inclusion criteria.
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Affiliation(s)
- Megan De Silva
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia
| | - William Chadwick
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia
| | - Navindhra Naidoo
- School of Health Sciences: Paramedicine, Western Sydney University, Locked Bag 1797, Penrith, Sydney, NSW, 2571, Australia.
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Jeong D, Lee GT, Park JE, Hwang SY, Kim T, Lee SU, Yoon H, Chul Cha W, Sim MS, Jo IJ, Shin TG. Prognostic Accuracy of SpO 2-based Respiratory Sequential Organ Failure Assessment for Predicting In-hospital Mortality. West J Emerg Med 2023; 24:1056-1063. [PMID: 38165187 PMCID: PMC10754194 DOI: 10.5811/westjem.59417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction In this study we aimed to investigate the prognostic accuracy for predicting in-hospital mortality using respiratory Sequential Organ Failure Assessment (SOFA) scores by the conventional method of missing-value imputation with normal partial pressure of oxygen (PaO2)- and oxygen saturation (SpO2)-based estimation methods. Methods This was a single-center, retrospective cohort study of patients with suspected infection in the emergency department. The primary outcome was in-hospital mortality. We compared the area under the receiver operating characteristics curve (AUROC) and calibration results of the conventional method (normal value imputation for missing PaO2) and six SpO2-based methods: using methods A, B, PaO2 is estimated by dividing SpO2 by a scale; with methods C and D, PaO2 was estimated by a mathematical model from a previous study; with methods E, F, respiratory SOFA scores was estimated by SpO2 thresholds and respiratory support use; with methods A, C, E are SpO2-based estimation for all PaO2 values, while methods B, D, F use such estimation only for missing PaO2 values. Results Among the 15,119 patients included in the study, the in-hospital mortality rate was 4.9%. The missing PaO2was 56.0%. The calibration plots were similar among all methods. Each method yielded AUROCs that ranged from 0.735-0.772. The AUROC for the conventional method was 0.755 (95% confidence interval [CI] 0.736-0.773). The AUROC for method C (0.772; 95% CI 0.754-0.790) was higher than that of the conventional method, which was an SpO2-based estimation for all PaO2 values. The AUROC for total SOFA score from method E (0.815; 95% CI 0.800-0.831) was higher than that from the conventional method (0.806; 95% CI 0.790-0.822), in which respiratory SOFA was calculated by the predefined SpO2 cut-offs and oxygen support. Conclusion In non-ICU settings, respiratory SOFA scores estimated by SpO2 might have acceptable prognostic accuracy for predicting in-hospital mortality. Our results suggest that SpO2-based respiratory SOFA score calculation might be an alternative for evaluating respiratory organ failure in the ED and clinical research settings.
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Affiliation(s)
- Daun Jeong
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Gun Tak Lee
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Jong Eun Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Sung Yeon Hwang
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Taerim Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Se Uk Lee
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Hee Yoon
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Won Chul Cha
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Min Seob Sim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Ik Joon Jo
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
| | - Tae Gun Shin
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Department of Emergency Medicine, Seoul, Korea
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Hwang SY, Kim IK, Jeong D, Park JE, Lee GT, Yoo J, Choi K, Shin TG, Kim K. Prognostic Performance of Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation III, and Simplified Acute Physiology Score II Scores in Patients with Suspected Infection According to Intensive Care Unit Type. J Clin Med 2023; 12:6402. [PMID: 37835046 PMCID: PMC10573563 DOI: 10.3390/jcm12196402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023] Open
Abstract
We investigated the prognostic performance of scoring systems by the intensive care unit (ICU) type. This was a retrospective observational study using data from the Marketplace for Medical Information in the Intensive Care IV database. The primary outcome was in-hospital mortality. We obtained Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) III, and Simplified Acute Physiology Score (SAPS) II scores in each ICU type. Prognostic performance was evaluated with the area under the receiver operating characteristic curve (AUROC) and was compared among ICU types. A total of 29,618 patients were analyzed, and the in-hospital mortality was 12.4%. The overall prognostic performance of APACHE III was significantly higher than those of SOFA and SAPS II (0.807, [95% confidence interval, 0.799-0.814], 0.785 [0.773-0.797], and 0.795 [0.787-0.811], respectively). The prognostic performance of SOFA, APACHE III, and SAPS II scores was significantly different between ICU types. The AUROC ranges of SOFA, APACHE III, and SAPS II were 0.723-0.826, 0.728-0.860, and 0.759-0.819, respectively. The neurosurgical and surgical ICUs had lower prognostic performance than other ICU types. The prognostic performance of scoring systems in patients with suspected infection is significantly different according to ICU type. APACHE III systems have the highest prediction performance. ICU type may be a significant factor in the prognostication.
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Affiliation(s)
- Sung-Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - In-Kyu Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Jong-Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Gun-Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Junsang Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Kihwan Choi
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
| | - Tae-Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (S.-Y.H.); (J.-E.P.)
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Republic of Korea
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Qiu X, Lei YP, Zhou RX. SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2023; 21:891-900. [PMID: 37450490 DOI: 10.1080/14787210.2023.2237192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. METHODS Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. RESULTS Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). CONCLUSIONS NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.
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Affiliation(s)
- Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu-Peng Lei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui-Xi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
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Dewitte K, Scheurwegs E, Van Ierssel S, Jansens H, Dams K, Roelant E. Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department. Int J Emerg Med 2022; 15:67. [PMID: 36513965 PMCID: PMC9745734 DOI: 10.1186/s12245-022-00472-y] [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: 07/27/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Different triage systems can be used to screen for sepsis and are often incorporated into local electronic health records. Often the design and interface of these digitalizations are not audited, possibly leading to deleterious effects on screening test performance. OBJECTIVE To audit a digital version of the MTS for detection of sepsis during triage in the ED. DESIGN A single-center retrospective study SETTINGS AND PARTICIPANTS: Patients (n=29766) presenting to an ED of a tertiary-care center who received formal triage were included. OUTCOME MEASURES AND ANALYSIS Calculated performance measures included sensitivity, specificity, likelihood ratios, and AUC for the detection of sepsis. Errors in the application of the specific sepsis discriminator of the MTS were recorded. MAIN RESULTS A total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 47 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5).
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Affiliation(s)
- Ken Dewitte
- grid.411414.50000 0004 0626 3418Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - Elyne Scheurwegs
- grid.5284.b0000 0001 0790 3681ADREM (Advanced Database Research and Modelling), Biomedical Informatics Research Center Antwerp (Biomina), University of Antwerp, Antwerpen, Belgium
| | - Sabrina Van Ierssel
- grid.411414.50000 0004 0626 3418Department of General Internal Medicine, infectious diseases and tropical medicine, Antwerp University Hospital, Edegem, Belgium
| | - Hilde Jansens
- grid.411414.50000 0004 0626 3418Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium
| | - Karolien Dams
- grid.411414.50000 0004 0626 3418Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Ella Roelant
- grid.411414.50000 0004 0626 3418Clinical Trial Center (CTC), Clinical Research Center Antwerp, Antwerp University Hospital, Edegem, Belgium
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Park H, Shin TG, Kim WY, Jo YH, Hwang YJ, Choi SH, Lim TH, Han KS, Shin J, Suh GJ, Kang GH, Kim KS. A quick Sequential Organ Failure Assessment-negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry. Clin Exp Emerg Med 2022; 9:84-92. [PMID: 35843608 PMCID: PMC9288871 DOI: 10.15441/ceem.22.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)-negative result (qSOFA score <2 points) at triage on the compliance with sepsis bundles among patients with sepsis who presented to the emergency department (ED). METHODS Prospective sepsis registry data from 11 urban tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed. Patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED triage. The primary outcome was defined as 3-hour bundle compliance, including lactate measurement, blood culture, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration. Multivariate logistic regression analysis to predict 3-hour bundle compliance was performed. RESULTS Among the 2,250 patients enrolled in the registry, 2,087 fulfilled the sepsis criteria. Only 31.4% (656/2,087) of the sepsis patients had qSOFA scores ≥2 points at triage. Patients with qSOFA scores <2 points had lower lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of compliance with lactate measurement (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.29-0.75), antibiotics administration (aOR, 0.64; 95% CI, 0.52-0.78), and 30 mL/kg crystalloid administration (aOR, 0.62; 95% CI, 0.49-0.77) within 3 hours from triage were significantly lower in patients with qSOFA scores <2 points. However, the rate of compliance with blood culture within 3 hours from triage (aOR, 1.66; 95% CI, 1.33-2.08) was higher in patients with qSOFA scores <2 points. CONCLUSION A qSOFA-negative result at ED triage is associated with low compliance with lactate measurement, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration within 3 hours in sepsis patients.
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Affiliation(s)
- Heesu Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jung Hwang
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Kap Su Han
- Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Gu Hyun Kang
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - for the Korean Shock Society investigators
- Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Guro Hospital, Korea University Medical Center, Seoul, Korea
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Korea University Anam Hospital, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Emergency Medicine, Hallym University College of Medicine, Seoul, Korea
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