Center for Health Policy, Primary Care and Outcomes Research, Stanford University, 117 Encina Commons, Stanford, CA 94305-6006, United States of America; Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, 795 Willow Road (152-MPD), Menlo Park, CA 94025, United States of America.
Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States of America.
Am J Emerg Med. 2019 Aug;37(8):1490-1497. doi: 10.1016/j.ajem.2018.10.058. Epub 2018 Nov 7.
The increasing use of sepsis screening in the Emergency Department (ED) and the Sepsis-3 recommendation to use the quick Sepsis-related Organ Failure Assessment (qSOFA) necessitates validation. We compared Systemic Inflammatory Response Syndrome (SIRS), qSOFA, and the National Early Warning Score (NEWS) for the identification of severe sepsis and septic shock (SS/SS) during ED triage.
This was a retrospective analysis from an urban, tertiary-care academic center that included 130,595 adult visits to the ED, excluding dispositions lacking adequate clinical evaluation (n = 14,861, 11.4%). The SS/SS group (n = 930) was selected using discharge diagnoses and chart review. We measured sensitivity, specificity, and area under the receiver-operating characteristic (AUROC) for the detection of sepsis endpoints.
NEWS was most accurate for triage detection of SS/SS (AUROC = 0.91, 0.88, 0.81), septic shock (AUROC = 0.93, 0.88, 0.84), and sepsis-related mortality (AUROC = 0.95, 0.89, 0.87) for NEWS, SIRS, and qSOFA, respectively (p < 0.01 for NEWS versus SIRS and qSOFA). For the detection of SS/SS (95% CI), sensitivities were 84.2% (81.5-86.5%), 86.1% (83.6-88.2%), and 28.5% (25.6-31.7%) and specificities were 85.0% (84.8-85.3%), 79.1% (78.9-79.3%), and 98.9% (98.8-99.0%) for NEWS ≥ 4, SIRS ≥ 2, and qSOFA ≥ 2, respectively.
NEWS was the most accurate scoring system for the detection of all sepsis endpoints. Furthermore, NEWS was more specific with similar sensitivity relative to SIRS, improves with disease severity, and is immediately available as it does not require laboratories. However, scoring NEWS is more involved and may be better suited for automated computation. QSOFA had the lowest sensitivity and is a poor tool for ED sepsis screening.
急诊科（ED）中脓毒症筛查的使用不断增加，以及脓毒症-3 建议使用快速脓毒症相关器官衰竭评估（qSOFA），这就需要对其进行验证。我们比较了全身炎症反应综合征（SIRS）、qSOFA 和国家早期预警评分（NEWS）在 ED 分诊中识别严重脓毒症和脓毒性休克（SS/SS）的能力。
这是一项回顾性分析，来自一个城市的三级学术中心，共纳入 130595 例成人 ED 就诊，排除了临床评估不充分的处置（n=14861，占 11.4%）。SS/SS 组（n=930）通过出院诊断和病历回顾选择。我们测量了检测脓毒症终点的敏感性、特异性和受试者工作特征曲线（ROC）下面积（AUROC）。
NEWS 对 SS/SS（AUROC=0.91、0.88、0.81）、脓毒性休克（AUROC=0.93、0.88、0.84）和脓毒症相关死亡率（AUROC=0.95、0.89、0.87）的分诊检测最准确，SIRS 和 qSOFA 分别为（p<0.01）。对于 SS/SS 的检测（95%CI），敏感性分别为 84.2%（81.5-86.5%）、86.1%（83.6-88.2%）和 28.5%（25.6-31.7%），特异性分别为 85.0%（84.8-85.3%）、79.1%（78.9-79.3%）和 98.9%（98.8-99.0%），NEWS≥4、SIRS≥2 和 qSOFA≥2。
NEWS 是检测所有脓毒症终点最准确的评分系统。此外，与 SIRS 相比，NEWS 具有更高的特异性和相似的敏感性，随着疾病严重程度的增加而提高，并且可以立即获得，因为它不需要实验室。然而，NEWS 的评分更复杂，可能更适合自动化计算。qSOFA 的敏感性最低，是 ED 脓毒症筛查的不良工具。
