Infection Service, Capital and Coast District Health Board, Wellington Hospital, Wellington, New Zealand.
Emergency Department, Capital and Coast District Health Board, Wellington Hospital, Wellington, New Zealand.
Emerg Med Australas. 2019 Jun;31(3):339-346. doi: 10.1111/1742-6723.13154. Epub 2018 Aug 20.
Use of the Sequential Organ Failure Assessment (SOFA) score has been proposed by the Third International Consensus Definitions for Sepsis and Septic Shock. The utility in the ED is not yet well established. We retrospectively studied the application of a modified SOFA (mSOFA) score, to assess its ability to predict mortality.
At our urban tertiary teaching hospital staff recorded patients with probable sepsis in the ED Information System (EDIS). Data was analysed for the year of July 2015 to June 2016. For a sample of the suspected sepsis patients, ED and inpatient clinical records were manually reviewed to ascribe an mSOFA score and assess its performance in predicting mortality, with a primary outcome of death by 30 days.
There were 474 patients recorded over the 1 year with probable sepsis, of whom 228 were manually reviewed. The mSOFA was a significant predictor of mortality at all the time points tested. The 30 day mortality was 22/88 (25%) for those with a positive mSOFA score and 3 out of 140 (2.1%) of those with a negative mSOFA score (OR 15.2, 95% CI [4.4, 52.7]; P < 0.001). This equated to a negative predictive value of 97.9% (95% exact CI 93.9-99.6%).
For ED patients thought likely to have sepsis, the mSOFA score distinguished those with a high or low mortality risk. The high negative predictive value could be practically useful. Prospective study of the mSOFA score used in ED will be needed to validate these observations.
序贯器官衰竭评估（SOFA）评分已被第三届国际脓毒症和脓毒性休克定义共识提出。其在急诊科的应用尚未得到充分证实。我们回顾性研究了改良 SOFA（mSOFA）评分的应用，以评估其预测死亡率的能力。
在我们的城市三级教学医院，工作人员在急诊科信息系统（EDIS）中记录疑似脓毒症患者。对 2015 年 7 月至 2016 年 6 月的数据进行分析。对疑似脓毒症患者的样本，对急诊科和住院部的临床记录进行手动审查，以确定 mSOFA 评分，并评估其在预测死亡率方面的表现，主要结局为 30 天内死亡。
在 1 年的时间里，有 474 名患者记录在案，其中 228 名患者进行了手动审查。mSOFA 是所有测试时间点死亡率的显著预测因子。mSOFA 评分阳性患者 30 天死亡率为 22/88（25%），mSOFA 评分阴性患者为 3/140（2.1%）（OR 15.2，95%CI [4.4, 52.7]；P < 0.001）。这相当于阴性预测值为 97.9%（95%精确 CI 93.9-99.6%）。
对于急诊科疑似患有脓毒症的患者，mSOFA 评分可以区分高死亡率和低死亡率风险的患者。高阴性预测值可能具有实际应用价值。需要前瞻性研究 mSOFA 评分在急诊科的应用，以验证这些观察结果。
