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Prognostic and discriminative accuracy of the quick Sepsis-related Organ Failure Assessment compared with an early warning score: a Danish cohort study
  1. Lise Skovgaard Svingel1,
  2. Merete Storgaard2,
  3. Buket Öztürk Esen1,
  4. Lotte Ebdrup2,
  5. Jette Ahrensberg3,
  6. Kim M Larsen4,
  7. Mette Nørgaard1,
  8. Henrik Toft Sørensen1,5,
  9. Christian Fynbo Christiansen1
  1. 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
  3. 3Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital, Aarhus, Denmark
  4. 4Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
  5. 5Department of Health Research and Policy and the Center for Population Health Sciences, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Lise Skovgaard Svingel, Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark; lisskg{at}clin.au.dk

Abstract

Background The clinical benefit of implementing the quick Sepsis-related Organ Failure Assessment (qSOFA) instead of early warning scores (EWS) to screen all hospitalised patients for critical illness has yet to be investigated in a large, multicentre study.

Methods We conducted a cohort study including all hospitalised patients ≥18 years with EWS recorded at hospitals in the Central Denmark Region during the year 2016. The primary outcome was intensive care unit (ICU) admission and/or death within 2 days following an initial EWS. Prognostic accuracy was examined using sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). Discriminative accuracy was examined by the area under the receiver operating characteristic curve (AUROC).

Results Among 97 332 evaluated patients, 1714 (1.8%) experienced the primary outcome. The qSOFA ≥2 was less sensitive (11.7% (95% CI: 10.2% to 13.3%) vs 25.1% (95% CI: 23.1% to 27.3%)) and more specific (99.3% (95% CI: 99.2% to 99.3%) vs 97.5% (95% CI: 97.4% to 97.6%)) than EWS ≥5. The NPV was similar for the two scores (EWS ≥5, 98.6% (95% CI: 98.6% to 98.7%) and qSOFA ≥2, 98.4% (95% CI: 98.3% to 98.5%)), while the PPV was 15.1% (95% CI: 13.8% to 16.5%) for EWS ≥5 and 22.4% (95% CI: 19.7% to 25.3%) for qSOFA ≥2. The AUROC was 0.72 (95% CI: 0.70 to 0.73) for EWS and 0.66 (95% CI: 0.65 to 0.67) for qSOFA.

Conclusion The qSOFA was less sensitive (qSOFA ≥2 vs EWS ≥5) and discriminatively accurate than the EWS for predicting ICU admission and/or death within 2 days after an initial EWS. This study did not support replacing EWS with qSOFA in all hospitalised patients.

  • acute care
  • epidemiology
  • intensive care
  • assessment
  • systems

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Footnotes

  • Handling editor Kirsty Challen

  • Contributors LSS was responsible for the interpretation of the data as well as writing the paper. MS contributed to the conception of the study and revised the manuscript for important intellectual content. BOE contributed to the conception of the study, was responsible for the analysis of data and revised the manuscript for important intellectual content. LE contributed to the conception of the study and revised the manuscript for important intellectual content. JA contributed to the conception of the study and revised the manuscript for important intellectual content. KML contributed to the conception of the study and revised the manuscript for important intellectual content. MN contributed to the design of the study and revised the manuscript for important intellectual content. HTS contributed to the design of the study and substantively revised the manuscript for important intellectual content. CFC conceived and designed the study, and contributed to the acquisition and interpretation of data. He also substantively revised the manuscript and oversaw the project. All authors reviewed and approved of the submitted version and are accountable for ensuring accuracy and integrity of the work. There is no one else who fulfils the criteria that has been excluded as an author.

  • Funding The study was supported by Aarhus University Hospital.

  • Competing interests LSS, BOE, MN, HTS and CFC are employees at Department of Clinical Epidemiology, Aarhus University Hospital, Denmark. The Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to and administered by Aarhus University. None of these studies are related to the current study. LSS, BOE, MN, HTS and CFC do not declare any personal conflicts of interest. MS, LE, JA and KML do not report any conflicts of interest.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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