首页|Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
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国家科技期刊平台
NETL
NSTL
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Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department
BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.
SepsisEmergency departmentClinical prediction ruleEarly warning scoreShock index
Rex Pui Kin Lam、Zonglin Dai、Eric Ho Yin Lau、Carrie Yuen Ting Ip、Ho Ching Chan、Lingyun Zhao、Tat Chi Tsang、Matthew Sik Hon Tsui、Timothy Hudson Rainer
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Department of Emergency Medicine,School of Clinical Medicine,Li Ka Shing Faculty of Medicine,the University of Hong Kong,Hong Kong,China
School of Public Health,Li Ka Shing Faculty of Medicine,the University of Hong Kong,Hong Kong,China
Accident and Emergency Department,Queen Mary Hospital,Hong Kong,China
Sepsis Emergency department Clinical prediction rule Early warning score Shock index
国家科技期刊平台
NSTL
万方数据
