Comparison of the quick Sepsis-Related Organ Failure Assessment (qSOFA) and Adult Sepsis Pathway in predicting adverse outcomes among adult patients on general wards

a retrospective observational cohort study

Ling Li, Kasun Rathnayake, Malcolm Green, Amith Shetty, Mary Fullick, Scott Walter, Catriona Middleton-Rennie, Michael Meller, Jeffrey Braithwaite, Harvey Lander, Johanna Westbrook

Research output: Contribution to journalArticle

Abstract

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 (SIRS) 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 (AUROC) for mortality was 0.76 (95% 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 (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.
Original languageEnglish
JournalInternal Medicine Journal
DOIs
Publication statusAccepted/In press - 6 Jan 2020

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Keywords

  • Sepsis
  • Hospital Mortality
  • quick screening test
  • early detection
  • adult sepsis pathway
  • qSOFA
  • SIRS

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