scholarly journals Prospective validation of quick Sequential Organ Failure Assessment (qSOFA) for mortality among patients with infection admitted to an emergency department

2019 ◽  
Vol 2 (3) ◽  
pp. 26
Author(s):  
Osama Bin Abdullah
Keyword(s):  
Emergency Department ◽  
Organ Failure ◽  
Predictive Value ◽  
Receiver Operating Curve ◽  
Registration System ◽  
Civil Registration ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Sensitivity Specificity ◽  
Admission Variables

Background: Only few prospective studies have evaluated the new quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in emergency department (ED) settings. The aim of this study was to determine the prognostic value of qSOFA compared to systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality of infected patients admitted to an ED.   Methods: A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital during 01.10.2017 to 31.03.2018. All patients with suspected or documented infection on arrival to the ED, and treated with antibiotics, were included. Admission variables included in the SIRS- and qSOFA criteria were prospectively obtained from triage forms. Information regarding 28-day mortality was obtained from the Danish Civil Registration System. The diagnostic performance of qSOFA and SIRS score for predicting 28-day mortality was assessed by analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC) with 95% confidence intervals (CI). Results: A total of 2,168 patients (47.42% male) were included. A total of 181 (8.35%) met at least two qSOFA criteria, and 1,046 (48.25%) met at least two SIRS criteria on admission. The overall 28-day mortality was 7.47% (95% CI 6.40-8.66%). Unadjusted odds ratio of qSOFA and SIRS for 28-day mortality was 2.93 (95% CI 1.92-4.47) vs 1.27 (95% CI 0.92-1.74), respectively. A qSOFA score of at least two for predicting 28-day mortality had a sensitivity of 19.10% (95% CI 13.40-26.00%), a specificity of 92.50% (95% CI 91.30-93.60%), a PPV and NPV of 17.10% (95% CI 11.90-23.40%) and 93.40% (95% CI 92.20-94.50%), respectively. A SIRS score of at least two for predicting 28-day mortality had a sensitivity of 53.70 (95% CI 45.70-61.60%), a specificity of 52.20% (95% CI 50.00-54.40%), a PPV and NPV of 8.32% (95% CI 6.72-10.20%) and 93.30% (95% CI 91.70-94.70%), respectively. The AUC for qSOFA and SIRS was 0.56 (95% CI 0.53-0.59) vs 0.53 (95% CI 0.49-0.57).   Conclusion: Use of qSOFA had improved specificity, but with poor sensitivity, in predicting in 28-day mortality. qSOFA and SIRS showed similar discrimination potential for mortality.

scholarly journals Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study

2019 ◽  
pp. emermed-2019-208456
Author(s):  
S M Osama Bin Abdullah ◽  
Rune Husås Sørensen ◽  
Ram Benny Christian Dessau ◽  
Saifullah Muhammed Rafid Us Sattar ◽  
Lothar Wiese ◽  
...  
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Likelihood Ratios ◽  
Registration System ◽  
Civil Registration ◽  
Prognostic Accuracy ◽  
Observational Cohort ◽  
Sensitivity Specificity ◽  
Sirs Criteria

BackgroundFew prospective studies have evaluated the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) criteria in emergency department (ED)settings. The aim of this study was to determine the prognostic accuracy of qSOFA compared with systemic inflammatory response syndrome (SIRS) in predicting the 28-day mortality of infected patients admitted to an ED.MethodsA prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital, Denmark, was conducted from 1 October 2017 to 31 March 2018. Patients were enrolled consecutively and data related to SIRS and qSOFA criteria were obtained from electronic triage record. Information regarding mortality was obtained from the Danish Civil Registration System. The original cut-off values of ≥2 was used to determine the prognostic accuracy of SIRS and qSOFA criteria for predicting 28-day mortality and was assessed by analyses of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).ResultsA total of 2112 patients were included in this study. A total of 175 (8.3%) patients met at least two qSOFA criteria, while 1012 (47.9%) met at least two SIRS criteria on admission. A qSOFA criteria of at least two for predicting 28-day mortality had a sensitivity of 19.5% (95% CI 13.6% to 26.5%) and a specificity of 92.6% (95% CI 91.4% to 93.7%). A SIRS criteria of at least two for predicting 28-day mortality had a sensitivity of 52.8% (95% CI 44.8% to 60.8%) and a specificity of 52.5% (95% CI 50.2% to 54.7%). The AUROC values for qSOFA and SIRS were 0.63 (95% CI 0.59 to 0.67) and 0.52 (95% CI 0.48 to 0.57), respectively.ConclusionBoth SIRS and qSOFA had poor sensitivity for 28-day mortality. qSOFA improved the specificity at the expense of the sensitivity resulting in slightly higher prognostic accuracy overall.

scholarly journals Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients:a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wenjuan Huang ◽  
Peng Yang ◽  
Feng Xu ◽  
Du Chen
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Study Endpoint ◽  
Trauma Patients ◽  
Roc Curve Analysis ◽  
Resuscitation Room ◽  
Failure Assessment ◽  
Qsofa Score

Abstract Background To explore the predictive value of the quick Sequential Organ Failure Assessment (qSOFA) score for death in the emergency department (ED) resuscitation room among adult trauma patients. Methods During the period November 1, 2016 to November 30, 2019, data was retrospectively collected of adult trauma patients triaged to the ED resuscitation room in the First Affiliated Hospital of Soochow University. Death occurring in the ED resuscitation room was the study endpoint. Univariate and multivariate analyses were performed to explore the association between qSOFA score and death. Receiver operating characteristic (ROC) curve analysis was also performed for death. Results A total of 1739 trauma victims were admitted, including 1695 survivors and 44 non-survivors. The death proportion raised with qSOFA score: 0.60% for qSOFA = 0, 3.28% for qSOFA = 1, 12.06% for qSOFA = 2, and 15.38% for qSOFA = 3, p < 0.001. Subgroup of qSOFA = 0 was used as a reference. In univariate analysis, crude OR for death with qSOFA = 1 was 5.65 [95% CI 2.25 to 14.24, p < 0.001], qSOFA = 2 was 22.85 [95% CI 8.84 to 59.04, p < 0.001], and qSOFA = 3 was 30.30 [95% CI 5.50 to 167.05, p < 0.001]. In multivariate analysis, with an adjusted OR (aOR) of 2.87 (95% CI 0.84 to 9.87, p = 0.094) for qSOFA = 1, aOR 6.80 (95% CI 1.79 to 25.90, p = 0.005) for qSOFA = 2, and aOR 24.42 (95% CI 3.67 to 162.27, p = 0.001) for qSOFA = 3. The Area Under the Curve (AUC) for predicting death in the ED resuscitation room among trauma patients was 0.78 [95% CI, 0.72–0.85]. Conclusions The qSOFA score can assess the severity of emergency trauma patients and has good predictive value for death in the ED resuscitation room.

scholarly journals Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department

2020 ◽  
Vol 17 (22) ◽  
pp. 8367
Author(s):  
Raúl López-Izquierdo ◽  
Pablo del Brio-Ibañez ◽  
Francisco Martín-Rodríguez ◽  
Alicia Mohedano-Moriano ◽  
Begoña Polonio-López ◽  
...  
Keyword(s):  
Emergency Department ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Initial Assessment ◽  
Failure Assessment ◽  
Risk Patients ◽  
Qsofa Score

The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54–81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75–0.87; p < 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0–91.4) and a specificity of 69.4 (95% CI: 66.1–72.5), and a SOFA of 0.909 (95% CI: 0.86–0.95; p < 0.001) with sensitivity of 87.7 (95% CI: 78.2–93.4) and specificity of 80.7 (95% CI: 77.4–83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

scholarly journals Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients：a retrospective study

2021 ◽  
Author(s):  
Wenjuan Huang ◽  
Peng Yang ◽  
Feng Xu ◽  
Du Chen
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Study Endpoint ◽  
Trauma Patients ◽  
Roc Curve Analysis ◽  
Resuscitation Room ◽  
Failure Assessment ◽  
Qsofa Score

Abstract Background To explore the predictive value of quick Sequential Organ Failure Assessment (qSOFA) score for death in emergency department (ED) resuscitation room among adult trauma patients.Methods During the period November 1, 2016 to November 30, 2019, we retrospectively collected data of adult trauma patients triaged to ED resuscitation room of the First Affiliated Hospital of Soochow University. Take death occurred in ED resuscitation room as the study endpoint. Univariate and multivariate analyses were performed to explore the association between qSOFA score and death. Receiver operating characteristic (ROC) curve analysis was also performed for death.Results A total of 1739 trauma victims were admitted, including 1695 survivors and 44 non-survivors. The death proportion raised with qSOFA score: 0.60% for qSOFA=0, 3.28% for qSOFA༝1, 12.06% for qSOFA༝2, and 15.38% for qSOFA༝3, p < 0.001. Subgroup of qSOFA = 0 was used as a reference. In univariate analysis, crude OR for death with qSOFA = 1 was 5.65 [95% CI 2.25 to 14.24, p < 0.001], qSOFA = 2 was 22.85 [95% CI 8.84 to 59.04, p < 0.001], and qSOFA = 3 was 30.30 [95% CI 5.50 to 167.05, p < 0.001]. In multivariate analysis, with an adjusted OR (aOR) of 2.87 (95% CI 0.84 to 9.87, p༝0.094) for qSOFA༝1, aOR 6.80 (95% CI 1.79 to 25.90, p = 0.005) for qSOFA༝2, and aOR 24.42 (95% CI 3.67 to 162.27, p = 0.001) for qSOFA༝3. The Area Under the Curve (AUC) for predicting death in ED resuscitation room among trauma patients was 0.78 [95% CI, 0.72–0.85].Conclusions qSOFA score can assess the severity of emergency trauma patients and has good predictive value for death in ED resuscitation room.

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 Skor prediksi sindrom disfungsi multi-organ pada pasien multitrauma

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Leo Rendy ◽  
Heber B. Sapan ◽  
Laurens T. B. Kalesaran ◽  
Julius H. Lolombulan
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Injury Severity Score ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Risk Score ◽  
Severity Score ◽  
Injury Severity ◽  
Failure Assessment ◽  
The Mean

Abstract: Multiple organ dysfunction syndrome (MODS) in patients with major trauma remains to be frequent and devastating complication during clinical course in emergency department and intensive care unit (ICU). The ability to easily and accurately identify patients at risk for MODS postinjury especially in multitrauma cases would be very valuable. This study aimed to construct an instrument for prediction of the development of MODS in adult multitrauma patients using clinical and laboratory data available in the first day at prahospital and emergency department (hospital) setting. This was a prospective study. Samples were adult multitrauma patients with Injury Severity Score (ISS) ≥16, aged 16-65 years old, admitted to 4 academic Level-I trauma center from September 2014 to September 2015. Sequential organ failure assessment (SOFA) score was used to determine MODS during hospitalization. A risk score created from the final regression model consisted of significant variables as MODS predictor. The results showed that there were 98 multitrauma patients as samples. The mean age was 35.2 years old; mostly male (85.71%); the mean of ISS was 23.6; mostly (76.53%) were caused by blunt injury mechanism. MODS was encountered in 43 patients (43.87%). The prediction risk score consists of Revised Trauma Score (RTS) (<7.25) and serum lactate level ≥2 mmol/L. This study also verified several independent risk factors for post multitrauma MODS, such as ISS >25, presence of SIRS, shock grade 2 or more, and white blood cell count >12,000/mm3. Conclusion: We derived a novel, simple, and applicable instrument to predict MODS in adult following multitrauma. The use of this scoring system may allow early identification of multitrauma patients who are at risk for MODS and result in more aggressive targeted resuscitation and better referral allocation based on regional trauma system.Keywords: MODS, multitrauma, emergency department, MODS prediction scoreAbstrak: Sindrom disfungsi multi-organ (MODS) merupakan komplikasi buruk yang sering terjadi sepanjang perjalanan klinis pasien trauma mayor di Unit Gawat Darurat (UGD) maupun di ruang perawatan intensif. Suatu nilai patokan yang dapat memprediksi MODS pascatrauma secara akurat sejak dini tentunya sangat berharga bagi tatalaksana pasien terutama pada kasus multitrauma. Penelitian ini bertujuan untuk membuat suatu instrumen yang dapat memrediksi perkembangan MODS pada pasien dewasa multitrauma dengan menggunakan data klinis dan laboratorium yang tersedia pada 24 jam pertama pasca trauma pada seting fase prahospital maupun di fase hospital sejak di UGD. Jenis penelitian ini prospektif, mengumpulkan pasien multitrauma dengan Injury Severity Score (ISS) ≥16, rentang usia 16-65 tahun, di 4 pusat trauma level-1 rumah sakit pendidikan selama 1 tahun (September 2014-2015). Dilakukan pencatatan data klinis dan laboratorium sesuai perkembangan pasien. Skor sequential organ failure assessment (SOFA) digunakan untuk menentukan adanya MODS selama perawatan. Skor prediksi dibuat dengan membangun model regresi logistik yang signifikan untuk memrediksi terjadinya MODS pasca multitrauma. Hasil penelitian mendapatkan 98 sampel multitrauma yang memenuhi kriteria inklusi dengan rerata usia 35,2 tahun, sebagian besar laki-laki (85,71%) dengan rerata ISS 23,6, dan disebabkan oleh trauma tumpul (76,53%). MODS terjadi pada 43 pasien (43,87%). Skor prediksi terdiri dari RTS dengan (cut off point 7,25) dan kadar laktat serum (cut off point 3,44 mmol/mL). Penelitian ini juga memverifikasi beberapa faktor risiko individual terjadinya MODS pasca multitrauma yaitu ISS>25, adanya SIRS, syok derajat 2 atau lebih, dan leukositosis >12.000. Simpulan: Kami melaporkan instrumen baru yang praktis untuk memrediksi MODS pada pasien multitrauma dewasa. Skor ini memungkinkan identifikasi dini pasien trauma yang berisiko akan mengalami MODS sehingga dapat menjadi tanda alarm dilakukannya resusitasi yang lebih agresif dan tepat serta alokasi rujukan pasien yang lebih efisien berdasarkan sistem trauma regional.Kata kunci: MODS, multitrauma, UGD, skor prediksi MODS

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

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