Wani Zuhaib Ahmed, Gulzar Khushboo, Yatoo Hilal, Kole Tamorish
Emergency, Sher-i-Kashmir Institute of Medical Sciences Medical College & Hospital, Srinagar, IND.
Obstetrics and Gynaecology, Directorate of Health Services Jammu & Kashmir, Srinagar, IND.
Cureus. 2023 May 19;15(5):e39251. doi: 10.7759/cureus.39251. eCollection 2023 May.
Sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year. The speed and appropriateness of therapy administered in the initial hours of treatment are likely to influence the outcome. We conducted a study to validate the clinical assessment score named 'quick sequential organ failure assessment' (qSOFA) score for use in the early identification of sepsis patients in the emergency department. Our primary objective was to see the sensitivity and specificity of the qSOFA-score for diagnosing sepsis in the emergency department and our secondary objective was to compare the sensitivity of the qSOFA score with the National Early Warning (NEW) score in patients with sepsis. A prospective observational study was conducted at Max Super Speciality Hospital Saket, New Delhi, from July 2016 to January 2017. Adult patients presenting to the emergency department with clinical signs and symptoms suggestive of infection were enrolled as per the eligibility criteria and divided into two groups on the basis of their qSOFA score at presentation. Out of 120 patients who had a positive qSOFA score 30 were subsequently confirmed as having sepsis whereas in qSOFA negative group 14 patients were subsequently diagnosed as having sepsis. This leads to the fact that although the test has near-acceptable specificity, the sensitivity is quite low. Calculations of the secondary outcome, that is 28-day mortality, revealed that 17 patients out of 120 who had a positive qSOFA score died within 28 days of first presentation whereas in the control group, nine patients had died. This means it successfully predicted mortality in only 17 patients and failed to predict mortality in nine patients out of 26 patients that died. The p-value is 0.097 which indicates both poor sensitivity as well as specificity for predicting mortality. We also compared qSOFA with the NEW score and found the latter to have a better sensitivity for detecting sepsis. This study shows that the qSOFA score, which has been specifically designed for early detection of sepsis patients in the emergency department or a pre-hospital setting in whom infection is suspected on a clinical basis, does not seem to be a good screening tool for early detection of sepsis patients in the emergency department.
脓毒症和脓毒性休克是重大的医疗保健问题，每年影响着全球数百万人。在治疗的最初几个小时内给予治疗的速度和恰当性可能会影响治疗结果。我们开展了一项研究，以验证名为“快速序贯器官衰竭评估”（qSOFA）评分的临床评估评分在急诊科早期识别脓毒症患者中的应用。我们的主要目标是观察qSOFA评分在急诊科诊断脓毒症的敏感性和特异性，次要目标是比较脓毒症患者中qSOFA评分与国家早期预警（NEW）评分的敏感性。2016年7月至2017年1月在新德里萨克特马克斯超级专科医院进行了一项前瞻性观察性研究。根据纳入标准，将出现提示感染的临床体征和症状的成年急诊科患者纳入研究，并根据其就诊时的qSOFA评分分为两组。在120例qSOFA评分呈阳性的患者中，有30例随后被确诊为脓毒症，而在qSOFA评分阴性组中，有14例患者随后被诊断为脓毒症。这导致这样一个事实，即尽管该检测具有接近可接受的特异性，但敏感性相当低。对次要结局（即28天死亡率）的计算显示，120例qSOFA评分呈阳性的患者中有17例在首次就诊后28天内死亡，而在对照组中，有9例患者死亡。这意味着它仅成功预测了26例死亡患者中的17例的死亡率，而未能预测9例患者的死亡率。p值为0.097，这表明在预测死亡率方面敏感性和特异性均较差。我们还将qSOFA与NEW评分进行了比较，发现后者在检测脓毒症方面具有更好的敏感性。这项研究表明，qSOFA评分专门设计用于在急诊科或院前环境中早期检测临床上怀疑有感染的脓毒症患者，但似乎并不是急诊科早期检测脓毒症患者的良好筛查工具。
