Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage

101Citations
Citations of this article
268Readers
Mendeley users who have this article in their library.

This article is free to access.

Abstract

Background: Sepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage. Methods: We performed a retrospective study of all patients transported by emergency medical services (EMS) to the Lausanne University Hospital (CHUV) over twelve months. All patients with a suspected or proven infection after the ED workup were included. We retrospectively analysed the sensitivity of the qSOFA score (≥2 criteria), SIRS criteria (≥2 clinical criteria) and sepsis definition (SIRS criteria + one sign of organ dysfunction or hypoperfusion) in the pre-hospital setting and at the ED triage as predictors of ICU admission, ICU stay of ≥3 days and early (i.e. 48 h) mortality. No direct comparison between the three tools was attempted. Results: Among 11,411 patients transported to the University hospital, 886 (7.8%) were included. In the pre-hospital setting, the sensitivity of qSOFA reached 36.3% for ICU admission, 17.4% for ICU stay of three days or more and 68.0% for 48 h mortality. The sensitivity of SIRS criteria reached 68.8% for ICU admission, 74.6% for ICU stay of three days or more and 64.0% for 48 h mortality. The sensitivity of sepsis definition did not reach 60% for any outcome. At ED triage, the sensitivity of qSOFA reached 31.2% for ICU admission, 30.5% for ICU stay of ≥3 days and 60.0% for mortality at 48 h. The sensitivity of SIRS criteria reached 58.8% for ICU admission, 57.6% for ICU stay of ≥3 days 80.0% for mortality at 48 h. The sensitivity of sepsis definition reached 60.0% for 48 h mortality. Discussion: Incidence of sepsis in the ED among patients transported by ambulance was 3.8 percent. This rate, associated to the mortality of sepsis, confirms the necessity to dispose of a test to early identify those patients. Conclusion: The sensitivity performance of all three tools was suboptimal. The qSOFA score, SIRS criteria and sepsis definition have low identification sensitivity in selecting septic patients in the pre-hospital setting or upon arrival in the ED at risk of complication.

References Powered by Scopus

The third international consensus definitions for sepsis and septic shock (sepsis-3)

17702Citations
N/AReaders
Get full text

The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure

8347Citations
N/AReaders
Get full text

Early goal-directed therapy in the treatment of severe sepsis and septic shock

8315Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Perforated and bleeding peptic ulcer: WSES guidelines

160Citations
N/AReaders
Get full text

Raising concerns about the Sepsis-3 definitions

85Citations
N/AReaders
Get full text

Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): Study protocol for a randomized controlled trial

66Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Tusgul, S., Carron, P. N., Yersin, B., Calandra, T., & Dami, F. (2017). Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25(1). https://doi.org/10.1186/s13049-017-0449-y

Readers over time

‘17‘18‘19‘20‘21‘22‘23‘24015304560

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 85

65%

Researcher 25

19%

Professor / Associate Prof. 14

11%

Lecturer / Post doc 7

5%

Readers' Discipline

Tooltip

Medicine and Dentistry 113

72%

Nursing and Health Professions 36

23%

Biochemistry, Genetics and Molecular Bi... 5

3%

Pharmacology, Toxicology and Pharmaceut... 4

3%

Article Metrics

Tooltip
Mentions
News Mentions: 2

Save time finding and organizing research with Mendeley

Sign up for free
0