Participant characteristics
| Author, year, reference | Total no of patients, no (group sizes) | Age (years) mean±SD, median (IQR) | Gender (% female) | Location of patients | When were scores calculated? | Participant selection criteria | Comparators | Outcome: Admission to ICU % (no of patients) | Outcome: Measured mortality | Outcome: Prevalence of mortality % (no of patients) |
| Goulden et al, 201820 | 1818 | 68±19 | 49 | ED and MAU | Based on arrival measurement | Suspected sepsis | qSOFA, NEWS, SIRS | 3% (53) | In-hospital mortality | 15% (265) |
| Churpek et al, 201721 | 30677 all patients: (18 523 ED; 12154 wards) | 58±18 all patients; 58±18.9 ED; 57±16.7 Wards | 53 all 55 ED; 48 wards | ED and wards | Retrospective calculation | Suspected infection based on whether they have had a blood culture and IV antibiotics | qSOFA, NEWS, MEWS, SIRS | 26% (4868 ED) 20% (2390 wards) No further data on this outcome alone (composite outcome) | In-hospital mortality | 5% (920 ED) 6% (729 wards) |
| Usman et al, 201822 | 115 734 (930 SS/SS) | 46.5±19.7 all patients: 63±17 SS/SS | 50.8 | ED | Based on arrival measurements | Sepsis codes or blood cultures, urine, or antibiotics or flagged by ED doctor. | qSOFA, NEWS, SIRS | Not investigated | Sepsis-related in-hospital mortality and all-cause mortality | 17.6% (164) sepsis related (0.6% (730) all-cause mortality—not just septic patients.) |
| Szakmany et al, 201823 | 380 all patients: (64 ED; 316 wards) | 74 (61–83) all patients | 53 | ED and wards | Used measurements at time sepsis was suspected. | Suspected or proven infection in patients with a NEWS ≥3. | qSOFA, NEWS, SIRS, SOFA | 3.7% (14) Given combined for ED and wards. No further data on this outcome. | 30-day all-cause mortality | 17.2% (11 ED) 21.2% (67 wards). |
| Samsudin et al, 201824 | 214 | 66.9±16.1 Combined from data in paper | 49.5 | ED | Arrival scores used for all scores except qSOFA where both initial and worst used. | Clinical suspicion of sepsis meeting 2 of 4 SIRS criteria in high triage category. | qSOFA, NEWS, HRV, SIRS | 5.14% (11) No further data on this outcome alone (composite outcome.) | 30-day in-hospital mortality | 18.7% (40) |
| de Groot et al, 201725 | 2280 | 61.1±17.0 | 42.3 | ED | Retrospective calculation | Suspected infection with a Manchester triage category of yellow, orange, red, or IV antibiotics. | qSOFA, NEWS, MEWS, MEDS, PIRO. | 9.6% (220) Note: Authors combined ICU/MCU | In-hospital mortality | 6.3% (143) |
| Redfern et al, 201826 | 241996 all patients: (81 170 ED admissions of which 40 782 with an infection code) | 63±20 all patients | 53 | ED and direct specialty referrals | Retrospective calculation | All admissions separated into no infection or infection depending on “suspicion of sepsis” ICD 10 codes. | qSOFA, NEWS, qNEWS | 9.65% (3937/40782) Primary or secondary infection codes admitted to ICU or death from the ED | In-hospital mortality | 8.09% (3298/40782) Primary or secondary infection codes from the ED |
| Redondo-González et al, 201827 | 349 | 72.7 (range 86) | 45.6 | ED | Retrospective calculation | Suspected infection plus two of a list of altered physiological parameters (including SIRS) | qSOFA, EWS (NEWS), SOFA, LODS | Not investigated | In-hospital mortality | 21.8% (76) |
| Innocenti et al, 201728 | 742 | 75±14 | 47 | ED-HDU and data taken from ED admission | Retrospective calculation | Patients admitted to ED-HDU with a diagnosis of sepsis, severe sepsis, or septic shock | qSOFA, MEWS, SOFA, MEDS, PRIO, APACHE II, CCI | Secondary outcome but no % given. (Looked at average scores at admission to ICU) | 28-day mortality | 31% (230) |
| Martino et al, 201829 | 310 | 78 (64–84) | 43 | ED | Retrospective calculation | Coded as sepsis (ICD-9 codes) | qSOFA, MEWS, SOFA, SIRS | 14.2% (43) | In-hospital mortality | 24.7% (75) |
| Liu and Hu 201830 | 584 | 59.5±17.2 | 34.35 | ED | Retrospective calculation | Severe sepsis (Sepsis-3 criteria) | qSOFA, MEWS, SIRS, MEDS, SOFA, APACHE II | Not investigated | 28-day mortality | 20.38% (119) |
| van der Woude et al, 201831 | 577 all patients: (198 with probable infection) | 55.3±18.6 all patients | 49.7 all patients | ED | Retrospective calculation | Random selection of medical patients in ED. Infection based on discharge diagnosis and independent review of the notes. | qSOFA, MEWS, SOFA, SIRS | 6.4% (37) all patients | In-hospital mortality | 3.6% (21) all patients |
| Brink et al, 201932 | 8204 | 57 (41–68) | 44.2 | ED | Retrospective calculation | Consecutive patients with suspected sepsis, defined as administration of intravenous antibiotics, taking of cultures/viral diagnostics. | qSOFA, NEWS, SIRS | Not investigated | 10-day and 30-day mortality | 3.5% (286) 10-day mortality 6.0% (490) 30-day mortality |
APACHE II, Acute Physiology and Chronic Health Evaluation Score; CCI, Charlson Comorbidity Index; ED, emergency department; EMU, emergency multidisciplinary unit; HDU, high-dependency unit; HRV, heart rate variability; ICD-9, International Classification of Disease 9; ICD-10, International Classification of Disease 10; ICU, intensive care unit; LODS, Logistic Organ Dysfunction Score; MAU, medical assessment unit; MCU, medium care unit; MEDS, Mortality in the Emergency Department Score; MEWS, Modified Early Warning Scores; NICE, National Institute for Health and Care Excellence; PIRO, predisposition, infection (or insult), response and organ dysfunction; qNEWS, quick National Early Warning Score; qSOFA, Quick Sequential Organ Failure Assessment; SIRS, Systemic inflammatory response syndrome; SS/SS, severe sepsis/septic shock.