Open AccessRelationship between the prehospital quick Sequential Organ Failure Assessment and prognosis in patients with sepsis or suspected sepsis: a population‐based ORION registry
Author(s) -
Hirose Tomoya,
Katayama Yusuke,
Ogura Hiroshi,
Umemura Yutaka,
Kitamura Tetsuhisa,
Mizushima Yasuaki,
Shimazu Takeshi
Publication year - 2021
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.675
Subject(s) - medicine , interquartile range , sepsis , odds ratio , confidence interval , glasgow coma scale , population , emergency department , emergency medicine , logistic regression , receiver operating characteristic , surgery , environmental health , psychiatry
Aim The quick Sequential Organ Failure Assessment (qSOFA) was proposed for use as a simple screening tool for sepsis. In this study, we evaluated the relationship between the prehospital use of qSOFA and prognosis in patients with sepsis or suspected sepsis using the population‐based Osaka Emergency Information Research Intelligent Operation Network (ORION) registry, which compiles prehospital ambulance data and in‐hospital information. Methods The study enrolled 437,974 patients in the ORION registry from January 1 to December 31, 2016. We selected hospitalized patients with sepsis or suspected sepsis using the appropriate codes from the International Classification of Diseases revision 10. We excluded patients with: (i) missing data (outcome, Japan Coma Scale, respiratory rate, and blood pressure); (ii) respiratory rate ≥60/min; and (iii) blood pressure ≥250 mmHg. These measures were evaluated by ambulance personnel when they first contacted the patient in the prehospital setting. The primary end‐point was discharge to death. Results In total, 12,646 patients (median age, 78 [interquartile range, 65–85] years; male, n = 6,760 [53.5%]) were eligible for our analysis. In a multivariable logistic regression analysis adjusted for confounding factors, the proportion of patients discharged to death was significantly higher for those evaluated as qSOFA positive (≥2 points) than qSOFA negative (≤1 point) (265/2,250 [11.78%] vs. 415/10,396 [3.99%]; adjusted odds ratio 2.91; 95% confidence interval, 2.47–3.43; P < 0.0001). The specificity and sensitivity were 83.4% and 39.0%, respectively, and the area under the receiver operating characteristic curve for qSOFA positive was 0.61. Conclusions The qSOFA evaluated by ambulance personnel in the prehospital setting was significantly associated with prognosis in patients with sepsis or suspected sepsis.