Background Sepsis is a major cause of morbidity and mortality and many tools exist to facilitate early recognition. This review compares two tools: the quick Sequential Organ Failure Assessment (qSOFA) and Early Warning Scores (National/Modified Early Warning Scores (NEWS/MEWS)) for predicting intensive care unit (ICU) admission and mortality when applied in the emergency department.
Methods A literature search was conducted using Medline, CINAHL, Embase and Cochrane Library, handsearching of references and a grey literature search with no language or date restrictions. Two authors selected studies and quality assessment completed using QUADAS-2. Area under the receiver operating characteristic curve (AUROC), sensitivities and specificities were compared.
Results 13 studies were included, totalling 403 865 patients. All reported mortality and six reported ICU admission.
The ranges for AUROC estimates varied from little better than chance to good prediction of mortality (NEWS: 0.59–0.88; qSOFA: 0.57–0.79; MEWS 0.56–0.75), however, individual papers generally reported higher AUROC values for NEWS than qSOFA. NEWS values demonstrated a tendency towards better sensitivity for ICU admission (NEWS ≥5, 46%-91%; qSOFA ≥2, 12%–53%) and mortality (NEWS ≥5, 51%–97%; qSOFA ≥2, 14%–71%) but lower specificity (ICU: NEWS ≥5, 25%–91%; qSOFA ≥2, 67%–99%; mortality: NEWS ≥5, 22%–91%; qSOFA ≥2, 58%–99%).
Conclusion The wide range of AUROC estimates and high heterogeneity limit our conclusions. Allowing for this, the NEWS AUROC was consistently higher than qSOFA within individual papers. Both scores allow threshold setting, determined by the preferred compromise between sensitivity and specificity. At established thresholds NEWS tended to higher sensitivity while qSOFA tended to a higher specificity.
PROSPERO registration number CRD42019131414.
- emergency department
- infectious diseases
- intensive care
- clinical assessment
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information
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Handling editor Kirsty Challen
Contributors All authors made substantial contribution to the conception and design (LS, SR and SG), search strategy, study selection, data extraction (LS and SR), analysis and interpretation (LS, SR and SG). LS drafted the article and all other authors revised it critically.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests SG is chief investigator for the PHEWS study (Pre-Hospital Early Warning Scores for Sepsis), funded by the National Institute for Health Research Health Technology Assessment Programme (Reference 17/136/10). This paper was not undertaken as part of the PHEWS study.
Provenance and peer review Not commissioned; externally peer reviewed.
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