title: Existing models fail to predict sepsis in an obstetric population with intrauterine infection.
abstract: OBJECTIVE
  Multiple scoring systems exist to identify inpatients who are at risk for clinical deterioration. None of these systems have been evaluated in an obstetric population. We examined the Systemic Inflammatory Response syndrome (SIRS) and Modified Early Warning score (MEWS) criteria in pregnant women with chorioamnionitis.
  
  
  METHODS
  This was an 18-month retrospective analysis of patients with chorioamnionitis. SIRS and MEWS scores were calculated; clinical outcomes were ascertained, and test characteristics were calculated for the primary outcome of sepsis, intensive care unit transfer, or death.
  
  
  RESULTS
  Nine hundred thirteen women with chorioamnionitis were identified. Five women experienced sepsis; there was 1 death. Five hundred seventy-five of the 913 women (63%) met SIRS criteria (95% confidence interval, 59.8-66.2%; positive predictive value, 0.9%). Ninety-two of the 913 women (10.3%) had a MEWS score of ≥ 5 (95% confidence interval, 8.3-12.2%; positive predictive value, 0.05%).
  
  
  CONCLUSIONS
  SIRS and MEWS criteria do not identify accurately patients who are at risk for intensive care unit transfer, sepsis, or death among pregnant women with intrauterine infection and should not be used in an obstetric setting.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA. Justin.Lappen@UHhospitals.org
authors.forename: Justin R
authors.initials: JR
authors.lastname: Lappen
authors.forename: Melissa
authors.initials: M
authors.lastname: Keene
authors.forename: Marybeth
authors.initials: M
authors.lastname: Lore
authors.forename: William A
authors.initials: WA
authors.lastname: Grobman
authors.forename: Dana R
authors.initials: DR
authors.lastname: Gossett
mesh_terms: D000328:Adult; D015984:Causality; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007362:Intensive Care Units; D009774:Obstetrics; D011237:Predictive Value of Tests; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy