Predictive performance of the qSOFA score in a population of Emergency Department Patients with Sepsis
CCCF ePoster library. Fernando S. Nov 1, 2016; 150968; 87
Dr. Shannon Fernando
Dr. Shannon Fernando
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Abstract
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#87

Topic: Retrospective or Prospective Cohort Study

Predictive performance of the qSOFA score in a population of Emergency Department Patients with Sepsis


Shannon M. Fernando, MD, MSc1; Douglas P. Barnaby, MD, MS2; Christophe L. Herry, PhD3; Polly E. Bijur, PhD2; Andrew J. E. Seely, MD, PhD3,4,
1Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; 2Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY, USA; 3Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada; 4Departments of Surgery and Critical Care, University of Ottawa, Ottawa, ON, Canada
 



Abstract:
Introduction: In the Emergency Department (ED), early identification of patients with infection at risk of subsequent deterioration is necessary in order to optimize patient outcomes, while efficiently managing resources. The quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) score based on three criteria (tachypnea, altered mental status and/or hypotension) has been recently introduced with the aim of providing the Emergency Physician with a simple bedside tool to help risk-stratify ED patients with sepsis. The predictive value of this tool in the Emergency Department requires prospective study in order to determine its optimal utility.
 
Objectives: We evaluated the ability of qSOFA in a population of patients presenting to the ED with sepsis to identify patients with severity adequate to lead to ICU admission with a length of stay ≥ 3days, or mortality, during their current hospital admission with a diagnosis of sepsis satisfying the 1992 SCCM/ACCP clinical criteria. A qSOFA positive test indicates 2 or more of the three criteria present.
 
Methods: Patients presenting to the ED satisfying study inclusion/exclusion criteria had vital signs measured by trained research associates and Glasgow Coma Scores calculated by treating clinicians. Patients were followed via the institution’s electronic medical record until discharge to detect achievement of one or both of the study endpoints (ICU LOS ≥ 3days, death). Patients meeting one of the study endpoints within one hour of arrival were excluded. Sensitivity, specificity, predictive values and likelihood ratios were calculated along with 95% confidence intervals (calculated with binomial proportion confidence interval).
 
Results: 704 patients presenting to either of two urban high-volume EDs within a single healthcare system were enrolled, of whom 45 (6.4%) met the primary outcome (see Table 1). 40 patients (6%) had a positive qSOFA (664 did not). A qSOFA score ≥2 had a sensitivity and specificity of 20% (95% CI [10%, 35%]) and 95% (95% CI [93%, 97%]) respectively, with corresponding positive and negative likelihood ratios of 4.3 (95% CI [2.2, 8.4]) and 0.8 (95% CI [0.7, 1.0]).
 
Conclusions: Our analysis suggest that a negative qSOFA does not rule out the potential for subsequent deterioration, whereas a positive qSOFA test connotes an increased risk for the outcome. Further multicenter evaluation will help clarify the clinical utility of this bedside tool.

References:
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:762-774.

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