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  • Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study

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Original article
Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study
  1. S M Osama Bin Abdullah1,
  2. Rune Husås Sørensen1,
  3. Ram Benny Christian Dessau2,3,
  4. Saifullah Muhammed Rafid Us Sattar4,
  5. Lothar Wiese5,
  6. Finn Erland Nielsen6
  1. 1 Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark
  2. 2 Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
  3. 3 Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
  4. 4 College of Medicine, China Three Gorges University, Yichang, China
  5. 5 Department of Infectious Diseases, Roskilde Hospital, Roskilde, Denmark
  6. 6 Department of Emergency Medicine, Bispebjerg Hospital, Copenhagen, Denmark
  1. Correspondence to Dr S M Osama Bin Abdullah, Department of Emergency Medicine, Slagelse Hospital, Slagelse 4200, Denmark; sabdu{at}regionsjaelland.dk

Abstract

Background Few prospective studies have evaluated the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) criteria in emergency department (ED)settings. The aim of this study was to determine the prognostic accuracy of qSOFA compared with systemic inflammatory response syndrome (SIRS) in predicting the 28-day mortality of infected patients admitted to an ED.

Methods A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital, Denmark, was conducted from 1 October 2017 to 31 March 2018. Patients were enrolled consecutively and data related to SIRS and qSOFA criteria were obtained from electronic triage record. Information regarding mortality was obtained from the Danish Civil Registration System. The original cut-off values of ≥2 was used to determine the prognostic accuracy of SIRS and qSOFA criteria for predicting 28-day mortality and was assessed by analyses of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).

Results A total of 2112 patients were included in this study. A total of 175 (8.3%) patients met at least two qSOFA criteria, while 1012 (47.9%) met at least two SIRS criteria on admission. A qSOFA criteria of at least two for predicting 28-day mortality had a sensitivity of 19.5% (95% CI 13.6% to 26.5%) and a specificity of 92.6% (95% CI 91.4% to 93.7%). A SIRS criteria of at least two for predicting 28-day mortality had a sensitivity of 52.8% (95% CI 44.8% to 60.8%) and a specificity of 52.5% (95% CI 50.2% to 54.7%). The AUROC values for qSOFA and SIRS were 0.63 (95% CI 0.59 to 0.67) and 0.52 (95% CI 0.48 to 0.57), respectively.

Conclusion Both SIRS and qSOFA had poor sensitivity for 28-day mortality. qSOFA improved the specificity at the expense of the sensitivity resulting in slightly higher prognostic accuracy overall.

  • emergency department
  • infectious diseases
  • death/mortality
  • clinical assessment
  • diagnosis

https://doi.org/10.1136/emermed-2019-208456

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    Footnotes

    • Contributors FEN conceived the idea and designed the study together with SMOBA. Data were analysed by FEN and RHS. SMOBA wrote the first draft of the manuscript. All authors interpreted data and revised the manuscript. All authors approved the final version of the manuscript.

    • Funding This project received financial support from Region Zealand Health Research Foundation and Naestved, Slagelse and Ringsted Hospitals Research Fund.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Danish Data Protection Agency (Project REG-105-2017). The Regional Committee on Health Research Ethics defined the study as a quality assurance project and therefore it was not covered by the Committee Act and without the obligation to report to the ethics committee system.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request and after the approval from the Danish Data Protection Agency.