Sepsis Clinical Criteria in Emergency Department Patients Admitted to an Intensive Care Unit: An External Validation Study of Quick Sequential Organ Failure Assessment.
BACKGROUND
Quick Sequential Organ Failure Assessment (qSOFA) is a prognostic score for patients with sepsis.


OBJECTIVE
Our aim was to compare the area under the receiver operating curve (AUROC), sensitivity, specificity, and likelihood ratios of qSOFA vs. systemic inflammation response syndrome (SIRS) in predicting in-hospital mortality among emergency department (ED) patients with suspected infection admitted to intensive care units (ICUs).


METHODS
We conducted a retrospective cohort chart review study of ED patients admitted to an ICU with suspected infection from August 1, 2012 to February 28, 2015. We included all patients with body fluid cultures sampled either during their ED stay without antibiotic administration or within 24 h of antibiotics administered in the ED. Trained chart abstractors blinded to the study hypothesis double-entered data from each patient's electronic medical record including demographic characteristics, vital signs, laboratory study results, physical examination findings, and in-hospital mortality. We then calculated the AUROC, sensitivity, specificity, and likelihood ratios for qSOFA and SIRS for predicting in-hospital mortality.


RESULTS
Of 214 patients admitted to an ICU with presumed sepsis, 39 (18.2%) died during hospitalization. The AUROC value was 0.65 (95% confidence interval [CI] 0.56-0.74) for SIRS vs. 0.66 (95% CI 0.57-0.76) for qSOFA; 2+ qSOFA criteria predicted in-hospital mortality with 89.7% sensitivity, 27.4% specificity, 1.2 positive likelihood ratio, and 0.4 negative likelihood ratio.


CONCLUSIONS
Among ED patients admitted to an ICU, the SIRS and qSOFA criteria had comparable prognostic value for predicting in-hospital mortality. These prognostic values are similar to those reported by the Sepsis-3 guidelines for ICU encounters.
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Michael D
MD
April
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Jose
J
Aguirre
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Lloyd I
LI
Tannenbaum
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Tyler
T
Moore
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Alexander
A
Pingree
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Robert E
RE
Thaxton
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
Daniel J
DJ
Sessions
Department of Emergency Medicine, San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.
James H
JH
Lantry
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018805:Sepsis / Q000145:classification* / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000145:classification / Q000175:diagnosis
critical care; emergency department; mortality; sepsis