scholarly journals P082: Predictive ability of the quick Sepsis-related Organ Failure Assessment score among patients with infection transported by paramedics: a Bayesian analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S93
Author(s):  
S. Alex Love ◽  
D. Lane
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Bayesian Analysis ◽  
Organ Failure ◽  
Predictive Ability ◽  
Decision Threshold ◽  
Coma Scale ◽  
C Statistic ◽  
Failure Assessment ◽  
Qsofa Score

Introduction: The quick Sepsis-related Organ Failure Assessment (qSOFA) score was developed to provide clinicians with a quick assessment for patients with latent organ failure possibly consistent with sepsis at high-risk for mortality. With the clinical heterogeneity of patients presenting with sepsis, a Bayesian validation approach may provide a better understanding of its clinical utility. This study used a Bayesian analysis to assess the prediction of hospital mortality by the qSOFA score among patients with infection transported by paramedics. Methods: A one-year cohort of adult patients transported by paramedics in a large, provincial EMS system was linked to Emergency Department (ED) and hospital administrative databases, then restricted to those patients with an ED diagnosed infection. A Bayesian binomial regression model was constructed using Hamiltonian Markov-Chain Monte-Carlo sampling, normal priors for each parameter, the calculated score, age and sex as the predictors, and hospital mortality as the outcome. Discrimination was assessed using posterior predictions to calculate a “Bayesian” C statistic, and calibration was assessed with calibration plots of the observed and predicted probability distributions. The independent predictive ability of each measure was tested by including each component measure (respiratory rate, Glasgow Coma Scale, and systolic blood pressure) as continuous predictors in a second model. Results: A total of 9,920 patients with ED diagnosed infection were included. 264 (2.7%) patients were admitted directly to the ICU, and 955 (9.6%) patients died in-hospital. As independent predictors, the probability of mortality increased as each measure became more extreme, with the Glasgow Coma Scale predicting the greatest change in mortality risk from a high to low score; however, no dramatic change in the probability supporting a single decision threshold was seen for any measure. For the calculated score, the C statistic for predicting mortality was 0.728. The calibration curve had no overlap of predictions, with a probability of 0.5 (50% credible interval 0.47-0.53) for patients with a qSOFA score of 3. Conclusion: Although no single decision threshold was identified for each component measure, a calculated qSOFA score provides good prediction of mortality for patients with ED diagnosed infection. When validating clinical prediction scores, a Bayesian approach may be used to assess probabilities of interest for clinicians to support better clinical decision making. Character count 2494

scholarly journals LO52: Classification versus prediction of mortality using the Systemic Inflammatory Response score and quick Sepsis-related Organ Failure Assessment scores in patients with infection

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S26
Author(s):  
D. Lane ◽  
S. Lin ◽  
D. Scales
Keyword(s):  
Decision Making ◽  
Inflammatory Response ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Mortality Risk ◽  
Classification Accuracy ◽  
Predictive Ability ◽  
C Statistic ◽  
Failure Assessment ◽  
Qsofa Score

Introduction: Despite their widespread use, measures of classification accuracy (i.e. sensitivity and specificity) have several limitations that conceals relevant information and may bias decision-making. Assessing the predictive ability of clinical tools instead may provide more useful prognostic information to support decision-making, particularly in an Emergency setting. We sought to contrast classification accuracy versus predictive ability of the Systemic Inflammatory Response Syndrome (SIRS) and quick Sepsis-related Organ Failure Assessment (qSOFA) Sepsis scores for determining mortality risk among patients with infection transported by paramedics. Methods: A one-year cohort of patients with infections transported to the Emergency Department by paramedics was linked to in-hospital administrative databases. Hospital mortality was determined for each patient at the time of discharge. We calculated sensitivity and specificity of SIRS and qSOFA for classifying hospital mortality across different score thresholds, and estimated discrimination (assessed using the C statistic) and calibration (assessed visually) of prediction. Prediction models for hospital mortality were constructed using the aggregated SIRS or qSOFA scores for each patient as a predictor, while accounting for clustering by institution and adjusting for differences in patient age and sex. Predicted and observed risk were plotted to assess calibration and change in risk across levels of each score. Results: A total of 10,409 patients with infection who were transported by paramedics were successfully linked, with an overall mortality rate of 9.2%. The median SIRS score among non-survivors was 2, while the median qSOFA score was 1. SIRS score had higher sensitivity estimates than qSOFA for classifying hospital mortality at all thresholds (0.11 – 0.83 vs. 0.08 – 0.80), but the qSOFA score had better discrimination (C statistic 0.76 vs. 0.71) and calibration. The risk of hospital mortality predicted by the SIRS score ranged from 6.6-24% across score values, whereas the risk predicted by the qSOFA score ranged from 8.6-53%. Conclusion: Assessing the SIRS and qSOFA scores predictive ability reveals that the qSOFA score provides more information to clinicians about a patient's mortality risk despite having worse sensitivity. This study highlights important limitations of classification accuracy for diagnostic test studies and supports a shift toward assessing predictive ability instead. Character count 2490

scholarly journals Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

2018 ◽  
Vol 35 (8) ◽  
pp. 810-817 ◽  
Author(s):  
Tushar Gupta ◽  
Michael A. Puskarich ◽  
Elizabeth DeVos ◽  
Adnan Javed ◽  
Carmen Smotherman ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Statistical Significance ◽  
Predictive Ability ◽  
Hospital Death ◽  
Icu Stay ◽  
Relative Contribution ◽  
Failure Assessment

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care. Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary). Results: Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( P = .092). Conclusion: In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.

scholarly journals In-hospital mortality and the Glasgow Coma Scale in the first 72 hours after traumatic brain injury

2011 ◽  
Vol 19 (6) ◽  
pp. 1337-1343 ◽  
Author(s):  
Cristina Helena Costanti Settervall ◽  
Regina Marcia Cardoso de Sousa ◽  
Silvia Cristina Fürbringer e Silva
Keyword(s):  
Glasgow Coma Scale ◽  
Hospital Mortality ◽  
Brain Injuries ◽  
Predictive Ability ◽  
Traumatic Brain Injuries ◽  
Receiver Operator Characteristic ◽  
Coma Scale ◽  
Initial Care ◽  
Predict Hospital Mortality ◽  
Severity Levels

This study verifies and compares the performance of three different scores obtained in the Glasgow Coma Scale (GCS) in the first 72 hours post trauma in predicting in-hospital mortality. The studied scores included those obtained after initial care was provided at the hospital, and the worst and best scores obtained in the scale in the first 72 hours post trauma. The scale’s predictive ability was assessed by the Receiver Operator Characteristic (ROC) curve. A total of 277 victims with different severity levels of blunt traumatic brain injuries were studied. The performance of the three scores that were analyzed to predict hospital mortality was moderate (0.74 to 0.79) and the areas under the curve did not present statistically significant differences. These findings suggest that any of the three studied scores can be applied in clinical practice to estimate the outcome of victims with blunt traumatic brain injuries, taking into consideration the instrument’s moderate discriminatory power.

scholarly journals The association between the quick sequential organ failure assessment score prior to emergency ICU admission and outcomes in adults with suspected infection

2020 ◽  
pp. 149-154
Author(s):  
S Pillay ◽  
T Kisten ◽  
HM Cassimjee
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Icu Mortality ◽  
Suspected Infection ◽  
Icu Admission ◽  
Icu Stay ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Length Of Icu Stay

Background: Sepsis and septic shock are leading causes of mortality world-wide. In patients outside the intensive care unit (ICU) a rising qSOFA (quick Sequential Organ Failure Assessment) score correlates with mortality risk. We sought to investigate if the duration of a qSOFA score ≥ 2 prior to ICU admission further affects outcomes, namely: ICU mortality, in-hospital mortality and length of ICU stay. Method: A retrospective chart review was performed using the electronic ICU database at a quaternary level hospital in Durban, KwaZulu-Natal, examining entries from 1 January 2008 to 31 December 2017. The review included 235 emergency in-hospital adult admissions with suspected infection, of which 144 had a qSOFA score ≥ 2 prior to ICU admission. Results: There was no significant association between the duration of a qSOFA score ≥ 2 prior to ICU admission and ICU mortality (p = 0.975), in-hospital mortality (p = 0.918) and length of ICU stay until demise (p = 0.848) or discharge (p = 0.624). The qSOFA score was significantly associated with ICU mortality with scores of 0, 1, 2 and 3 resulting in ICU mortality rates of 0%, 22.5%, 53.7% and 84.6% respectively (p < 0.001). Conclusion: The duration of a qSOFA score ≥ 2 prior to emergency ICU admission was not significantly associated with ICU mortality, in-hospital mortality or length of ICU stay in adults with suspected infection.

scholarly journals Development of a Simple Sequential Organ Failure Assessment Score for Risk Assessment of Emergency Department Patients With Sepsis

2017 ◽  
Vol 35 (3) ◽  
pp. 270-278 ◽  
Author(s):  
Faheem W. Guirgis ◽  
Michael A. Puskarich ◽  
Carmen Smotherman ◽  
Sarah A. Sterling ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sensitivity And Specificity ◽  
Sofa Score ◽  
External Validation ◽  
Predictive Ability ◽  
Failure Assessment ◽  
Validation Set

Objectives: Sepsis-3 recommends using the quick Sequential Organ Failure Assessment (qSOFA) score followed by SOFA score for sepsis evaluation. The SOFA is complex and unfamiliar to most emergency physicians, while qSOFA is insensitive for sepsis screening and may result in missed cases of sepsis. The objective of this study was to devise an easy-to-use simple SOFA score for use in the emergency department (ED). Methods: Retrospective study of ED patients with sepsis with in-hospital mortality as the primary outcome. A simple SOFA score was derived and validated and compared with SOFA and qSOFA. Results: A total of 3297 patients with sepsis were included, and in-hospital mortality was 10.1%. Simple SOFA had a sensitivity and specificity of 88% and 44% in the derivation set and 93% and 44% in the validation set for in-hospital mortality, respectively. The sensitivity and specificity of qSOFA was 38% and 86% and for SOFA was 90% and 50%, respectively. There were 2760 (84%) of 3297 qSOFA-negative (<2) patients. In this group, simple SOFA had a sensitivity and specificity of 86% and 48% in the derivation set and 91% and 48% in the validation set, respectively. Sequential Organ Failure Assessment was 86% sensitive and 57% specific in qSOFA-negative patients. For all encounters, the areas under the receiver–operator characteristic curves (AUROC) were 0.82 for SOFA, 0.78 (derivation) and 0.82 (validation) for simple SOFA, and 0.68 for qSOFA. In qSOFA-negative patients, the AUROCs were 0.80 for SOFA and 0.76 (derivation) and 0.82 (validation) for simple SOFA. Conclusions: Simple SOFA demonstrates similar predictive ability for in-hospital mortality from sepsis compared to SOFA. External validation of these findings is indicated.

scholarly journals Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries

JAMA ◽  
2018 ◽  
Vol 319 (21) ◽  
pp. 2202 ◽  
Author(s):  
Kristina E. Rudd ◽  
Christopher W. Seymour ◽  
Adam R. Aluisio ◽  
Marc E. Augustin ◽  
Danstan S. Bagenda ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Organ Failure ◽  
Middle Income ◽  
Suspected Infection ◽  
Middle Income Countries ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Low And Middle Income

Sepsis nach elektiver Septumplastik und Nasenmuschelverkleinerung

2019 ◽  
Vol 98 (08) ◽  
pp. 571-574
Author(s):  
Katharina Stölzel ◽  
Lichun Zhang ◽  
Tordis Borowski ◽  
Heidi Olze ◽  
Tim Schroeder ◽  
...  
Keyword(s):  
Organ Failure ◽  
Assessment Score ◽  
Failure Assessment ◽  
Qsofa Score

FallberichtEin 20-jähriger adipöser Patient stellte sich im August 2018 in einer auswärtigen Klinik zur Septumplastik und Muschelverkleinerung bei Septumdeviation und Muschelhyperplasie ohne relevante Vorerkrankungen vor. Intraoperativ war keine Antibiotikagabe erfolgt. Postoperativ wurde der Patient zur weiteren Betreuung mit Doyle-Splinten und Gelaspon® auf die Normalstation verlegt. Es war Hochsommer und die Krankenzimmertemperatur bei ausgefallener Klimaanlage sehr hoch. Wie erst später fremdanamnestisch bekannt wurde, hatte der Patient eine bereits vor stationärer Aufnahme mehrere Tage bestehende, aber nicht mitgeteilte Enteritis. Am Morgen des ersten postoperativen Tages wies der Patient Zeichen der Sepsis auf: arterielle Hypotonie, Tachykardie, Tachypnoe und Desorientierung (= quick Sepsis – related organ failure assessment Score [qSOFA Score] = positiv). Es erfolgte die Gabe von Kristalloiden und bei Schwellung des Gesichtes die Entfernung der Doyle-Splinte. Ungeachtet dessen kam es zur progredienten Verschlechterung und Entwicklung eines schweren Schocks, so dass mit der Gabe von Vasopressoren begonnen wurde. Bei zusätzlich beginnender respiratorischer Erschöpfung wurde die Indikation zur Intubation gestellt. Während der Intubation kam es zur Aspiration. Zur weiteren intensivmedizinischen Versorgung erfolgte aus kapazitären Gründen die Verlegung auf die interdisziplinäre internistische Intensivstation unserer Klinik mit zunächst unklarem Infektfokus. Bei Übernahme war der Patient intubiert und beatmet (CPAP PEEP 9 mbar, Druckunterstützung 16 mbar, FiO2 0,8) und hoch katecholaminpflichtig (Noradrenalin 1 µg/kg/min, Epinephrin 0,2 µg/kg/min).

scholarly journals Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

2021 ◽  
Vol 4 (6) ◽  
pp. e2113891
Author(s):  
William Dwight Miller ◽  
Xuan Han ◽  
Monica E. Peek ◽  
Deepshikha Charan Ashana ◽  
William F. Parker
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Standards Of Care ◽  
Assessment Score ◽  
Failure Assessment
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