title: An Emergency Department Validation of the SEP-3 Sepsis and Septic Shock Definitions and Comparison With 1992 Consensus Definitions.
abstract: OBJECTIVE
  The Third International Consensus Definitions Task Force (SEP-3) proposed revised criteria defining sepsis and septic shock. We seek to evaluate the performance of the SEP-3 definitions for prediction of inhospital mortality in an emergency department (ED) population and compare the performance of the SEP-3 definitions to that of the previous definitions.
  
  
  METHODS
  This was a secondary analysis of 3 prospectively collected, observational cohorts of infected ED subjects aged 18 years or older. The primary outcome was all-cause inhospital mortality. In accordance with the SEP-3 definitions, we calculated test characteristics of sepsis (quick Sequential Organ Failure Assessment [qSOFA] score ≥2) and septic shock (vasopressor dependence plus lactate level >2.0 mmol/L) for mortality and compared them to the original 1992 consensus definitions.
  
  
  RESULTS
  We identified 7,754 ED patients with suspected infection overall; 117 had no documented mental status evaluation, leaving 7,637 patients included in the analysis. The mortality rate for the overall population was 4.4% (95% confidence interval [CI] 3.9% to 4.9%). The mortality rate for patients with qSOFA score greater than or equal to 2 was 14.2% (95% CI 12.2% to 16.2%), with a sensitivity of 52% (95% CI 46% to 57%) and specificity of 86% (95% CI 85% to 87%) to predict mortality. The original systemic inflammatory response syndrome-based 1992 consensus sepsis definition had a 6.8% (95% CI 6.0% to 7.7%) mortality rate, sensitivity of 83% (95% CI 79% to 87%), and specificity of 50% (95% CI 49% to 51%). The SEP-3 septic shock mortality was 23% (95% CI 16% to 30%), with a sensitivity of 12% (95% CI 11% to 13%) and specificity of 98.4% (95% CI 98.1% to 98.7%). The original 1992 septic shock definition had a 22% (95% CI 17% to 27%) mortality rate, sensitivity of 23% (95% CI 18% to 28%), and specificity of 96.6% (95% CI 96.2% to 97.0%).
  
  
  CONCLUSIONS
  Both the new SEP-3 and original sepsis definitions stratify ED patients at risk for mortality, albeit with differing performances. In terms of mortality prediction, the SEP-3 definitions had improved specificity, but at the cost of sensitivity. Use of either approach requires a clearly intended target: more sensitivity versus specificity.
authors.affiliation: Division of Emergency Medicine, University of Washington, Seattle, WA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Henning
authors.affiliation: Department of Emergency Medicine, University of Mississippi, Jackson, MS.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Puskarich
authors.affiliation: Department of Emergency Medicine, Vanderbilt, Nashville, TN.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, IL.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.affiliation: Department of Emergency Medicine, University of Mississippi, Jackson, MS.
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: nshapiro@bidmc.harvard.edu.
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026683:Advisory Committees; D004636:Emergency Service, Hospital; D038801:International Classification of Diseases; D064887:Observational Studies as Topic; D063305:Organ Dysfunction Scores; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D003245:Consensus Statements as Topic
chemical_list: D014662:Vasoconstrictor Agents