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 journalArticleResearchpeer-review

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.
LanguageEnglish
JournalInternal Medicine Journal
DOIs
Publication statusAccepted/In press - 6 Jan 2020

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Patients' Rooms
Observational Studies
Sepsis
Cohort Studies
Hospital Mortality
Intensive Care Units
Systemic Inflammatory Response Syndrome
Infection

Keywords

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

Cite this

@article{ee5ce1a6efaa443e8859af3d9b0a9b2c,
title = "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",
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.",
keywords = "Sepsis, Hospital Mortality, quick screening test, early detection, adult sepsis pathway, qSOFA, SIRS",
author = "Ling Li and Kasun Rathnayake and Malcolm Green and Amith Shetty and Mary Fullick and Scott Walter and Catriona Middleton-Rennie and Michael Meller and Jeffrey Braithwaite and Harvey Lander and Johanna Westbrook",
year = "2020",
month = "1",
day = "6",
doi = "10.1111/imj.14746",
language = "English",
journal = "Internal Medicine Journal",
issn = "1444-0903",
publisher = "Wiley-Blackwell, Wiley",

}

TY - JOUR

T1 - Comparison of the quick Sepsis-Related Organ Failure Assessment (qSOFA) and Adult Sepsis Pathway in predicting adverse outcomes among adult patients on general wards

T2 - Internal Medicine Journal

AU - Li, Ling

AU - Rathnayake, Kasun

AU - Green, Malcolm

AU - Shetty, Amith

AU - Fullick, Mary

AU - Walter, Scott

AU - Middleton-Rennie, Catriona

AU - Meller, Michael

AU - Braithwaite, Jeffrey

AU - Lander, Harvey

AU - Westbrook, Johanna

PY - 2020/1/6

Y1 - 2020/1/6

N2 - 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.

AB - 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.

KW - Sepsis

KW - Hospital Mortality

KW - quick screening test

KW - early detection

KW - adult sepsis pathway

KW - qSOFA

KW - SIRS

U2 - 10.1111/imj.14746

DO - 10.1111/imj.14746

M3 - Article

JO - Internal Medicine Journal

JF - Internal Medicine Journal

SN - 1444-0903

ER -