Sabir, L. orcid.org/0000-0001-6488-3314, Ramlakhan, S. and Goodacre, S. orcid.org/0000-0003-0803-8444 (2022) Comparison of qSOFA and Hospital Early Warning Scores for prognosis in suspected sepsis in emergency department patients : a systematic review. Emergency Medicine Journal, 39 (4). pp. 284-294. ISSN 1472-0205
Abstract
Background: Sepsis is a major cause of morbidity and mortality and many tools exist to facilitate early recognition. This review compares two tools: the quick Sequential Organ Failure Assessment (qSOFA) and Early Warning Scores (National/Modified Early Warning Scores (NEWS/MEWS)) for predicting intensive care unit (ICU) admission and mortality when applied in the emergency department.
Methods: A literature search was conducted using Medline, CINAHL, Embase and Cochrane Library, handsearching of references and a grey literature search with no language or date restrictions. Two authors selected studies and quality assessment completed using QUADAS-2. Area under the receiver operating characteristic curve (AUROC), sensitivities and specificities were compared.
Results: 13 studies were included, totalling 403 865 patients. All reported mortality and six reported ICU admission.
The ranges for AUROC estimates varied from little better than chance to good prediction of mortality (NEWS: 0.59–0.88; qSOFA: 0.57–0.79; MEWS 0.56–0.75), however, individual papers generally reported higher AUROC values for NEWS than qSOFA. NEWS values demonstrated a tendency towards better sensitivity for ICU admission (NEWS ≥5, 46%-91%; qSOFA ≥2, 12%–53%) and mortality (NEWS ≥5, 51%–97%; qSOFA ≥2, 14%–71%) but lower specificity (ICU: NEWS ≥5, 25%–91%; qSOFA ≥2, 67%–99%; mortality: NEWS ≥5, 22%–91%; qSOFA ≥2, 58%–99%).
Conclusion: The wide range of AUROC estimates and high heterogeneity limit our conclusions. Allowing for this, the NEWS AUROC was consistently higher than qSOFA within individual papers. Both scores allow threshold setting, determined by the preferred compromise between sensitivity and specificity. At established thresholds NEWS tended to higher sensitivity while qSOFA tended to a higher specificity.
PROSPERO registration number: CRD42019131414.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 Author(s) (or their employer(s)). Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC-BY-NC 4.0) license (https://creativecommons.org/licenses/by-nc/4.0/). |
Keywords: | clinical assessment; death/mortality; emergency department; infectious diseases; intensive care |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 05 Oct 2021 11:03 |
Last Modified: | 23 Jun 2022 09:10 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Refereed: | Yes |
Identification Number: | 10.1136/emermed-2020-210416 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:178860 |
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