Yu Sean C, Shivakumar Nirmala, Betthauser Kevin, Gupta Aditi, Lai Albert M, Kollef Marin H, Payne Philip R O, Michelson Andrew P
Institute for Informatics, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Department of Biomedical Engineering, Washington University School in St. Louis, St. Louis, Missouri, USA.
JAMIA Open. 2021 Aug 2;4(3):ooab062. doi: 10.1093/jamiaopen/ooab062. eCollection 2021 Jul.
The objective of this study was to directly compare the ability of commonly used early warning scores (EWS) for early identification and prediction of sepsis in the general ward setting. For general ward patients at a large, academic medical center between early-2012 and mid-2018, common EWS and patient acuity scoring systems were calculated from electronic health records (EHR) data for patients that both met and did not meet Sepsis-3 criteria. For identification of sepsis at index time, National Early Warning Score 2 (NEWS 2) had the highest performance (area under the receiver operating characteristic curve: 0.803 [95% confidence interval [CI]: 0.795-0.811], area under the precision recall curves: 0.130 [95% CI: 0.121-0.140]) followed NEWS, Modified Early Warning Score, and quick Sequential Organ Failure Assessment (qSOFA). Using validated thresholds, NEWS 2 also had the highest recall (0.758 [95% CI: 0.736-0.778]) but qSOFA had the highest specificity (0.950 [95% CI: 0.948-0.952]), positive predictive value (0.184 [95% CI: 0.169-0.198]), and F1 score (0.236 [95% CI: 0.220-0.253]). While NEWS 2 outperformed all other compared EWS and patient acuity scores, due to the low prevalence of sepsis, all scoring systems were prone to false positives (low positive predictive value without drastic sacrifices in sensitivity), thus leaving room for more computationally advanced approaches.
本研究的目的是直接比较常用早期预警评分（EWS）在普通病房环境中早期识别和预测脓毒症的能力。对于2012年初至2018年年中期间一家大型学术医疗中心的普通病房患者，根据符合和不符合脓毒症-3标准的患者的电子健康记录（EHR）数据计算常见的EWS和患者 acuity评分系统。对于在索引时间识别脓毒症，国家早期预警评分2（NEWS 2）表现最佳（受试者操作特征曲线下面积：0.803[95%置信区间（CI）：0.795-0.811]，精确召回曲线下面积：0.130[95%CI：0.121-0.140]），其次是NEWS、改良早期预警评分和快速序贯器官衰竭评估（qSOFA）。使用经过验证的阈值，NEWS 2的召回率也最高（0.758[95%CI：0.736-0.778]），但qSOFA的特异性最高（0.950[95%CI：0.948-0.952]）、阳性预测值（0.184[95%CI：0.169-0.198]）和F1分数（0.236[95%CI：0.220-0.253]）。虽然NEWS 2优于所有其他比较的EWS和患者 acuity评分，但由于脓毒症的患病率较低，所有评分系统都容易出现假阳性（阳性预测值低，且敏感性没有大幅牺牲），因此为更先进的计算方法留出了空间。
