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qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis
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  • Published on:
    Reply to Zhou and Wu
    • Robert Goulden, Academic foundation doctor Royal Liverpool University Hospital
    • Other Contributors:
      • Emmanuel Nsutebu, Consultant Infectious Diseases Physician and Associate Medical Director for Deterioration and Sepsis

    We would like to thank Zhou and Wu for their thoughtful comments on our paper.

    The discrepancy in Table 1 between the first and second to last row is due to an error. The first row should note ‘Admitted to ICU (n=53)’.

    The NEWS, SIRS, and qSOFA scores were directly recorded in the patient electronic medical record (EMR), and our initial step was to extract these scores from the EMR. When these values were missing, the individual components of the scores were extracted from paper records, and the scores calculated. The high number of missing values of the qSOFA were due to the fact that it was not routinely recorded until part way through the study period. The fact that 6% of subjects still had missing values after manual chart review resulted from one or more of the components of any of the three scores not being recorded (or the record being missing) when the patient initially presented to the emergency department (ED).

    Regarding the time window, the qSOFA, NEWS, and SIRS scores used in our analysis were all based on their initial values when the patient was assessed, which would typically be within minutes of ED arrival. This therefore reflects the values upon which clinicians initially treating the patients would base their decisions.

    The high proportion of patients who died that were not admitted to ICU reflects the fact that many patients with advanced age and co-morbidities ultimately die from infection, which at some stage may meet sepsis...

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    Conflict of Interest:
    None declared.
  • Published on:
    The relationship between qSOFA score and NEWS score
    • Xianshi Zhou, Emergency department physician Guangdong Provincial Hospital of Chinese Medicine
    • Other Contributors:
      • Fanwei Wu, Chinese Medicine Practioners

    The relationship between qSOFA score and NEWS score

    We read with interest the paper by Goulden R and colleagues 1 who compare the efficacy of qSOFA, SIRS and NEWS score in predicting the inhospital mortality of septic patients. Though the research seems to be scientific, we still have some concerns to put forward.
    To begin with, there are some minor errs existed in Table 1 of the commented paper 1, as indicated in the first row of Table 1, the total number who was admitted to the intensive care unit (ICU) was 52, however, the second row from the bottom of Table 1 indicates 53 persons had ICU admission, so, how to explain this discordance?
    Additionally, according to the data provided by Goulden R et al, the study initially included 1942 patients, nevertheless, to our surprise, 1117 (58%) of them had missing values of qSOFA score, far more than the number of 103 (5%) and 335 (17%) who had missing SIRS scores and missing NEWS scores respectively. There were still 6% missing values in the final analysis of 1818 patients, though most of missing values were supplemented by manual review of paper charts, thus, we are afraid that the major missing values were from qSOFA score, which will result in underestimated sensitivity of qSOFA in predicting the inhospital mortality. As we all know, the qSOFA score contains 3 elements 2 - respiratory rate, mental status, and systolic blood pressure, while NEWS score incorporates 7 elements - respiratory rate, mental stat...

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    Conflict of Interest:
    None declared.