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Comparison of the quick Sepsis‐related Organ Failure Assessment and adult sepsis pathway in predicting adverse outcomes among adult patients in general wards: a retrospective observational cohort study
Author(s) -
Li Ling,
Rathnayake Kasun,
Green Malcolm,
Shetty Amith,
Fullick Mary,
Walter Scott,
MiddletonRennie Catriona,
Meller Michael,
Braithwaite Jeffrey,
Lander Harvey,
Westbrook Johanna I.
Publication year - 2021
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.14746
Subject(s) - medicine , sepsis , interquartile range , early warning score , retrospective cohort study , intensive care unit , cohort study , confidence interval , emergency medicine , observational study , adverse effect , systemic inflammatory response syndrome , cohort , intensive care medicine
Background Quick Sepsis‐related Organ Failure Assessment (qSOFA) is recommended for use by the most recent international sepsis definition taskforce to identify suspected sepsis in patients outside the intensive care unit (ICU) at risk of adverse outcomes. Evidence of its comparative effectiveness with existing sepsis recognition tools is important to guide decisions about its widespread implementation. Aim To compare the performance of qSOFA with the adult sepsis pathway (ASP), a current sepsis recognition tool widely used in NSW hospitals and systemic inflammatory response syndrome criteria in predicting adverse outcomes in adult patients on general wards. Methods A retrospective observational cohort study was conducted which included all adults with suspected infections admitted to a Sydney teaching hospital between December 2014 and June 2016. The primary outcome was in‐hospital mortality with two secondary composite outcomes. Results Among 2940 patients with suspected infection, 217 (7.38%) died in‐hospital and 702 (23.88%) were subsequently admitted to ICU. The ASP showed the greatest ability to correctly discriminate in‐hospital mortality and secondary outcomes. The area under the receiver‐operating characteristic curve for mortality was 0.76 (95% confidence interval (CI): 0.74–0.78), compared to 0.64 for the qSOFA tool (95% CI: 0.61–0.67, P < 0.0001). Median time from the first ASP sepsis warning to death was 8.21 days (interquartile range (IQR): 2.29–16.75) while it was 0 days for qSOFA (IQR: 0–2.58). Conclusions The ASP demonstrated both greater prognostic accuracy and earlier warning for in‐hospital mortality for adults on hospital wards compared to qSOFA. Hospitals already using ASP may not benefit from switching to the qSOFA tool.