Performance of scores in the prediction of clinical outcomes in patients admitted from the emergency service.
Luana Matuella Figueira da Silva, Luciano Passamini Diogo, Letícia Becker Vieira and 3 others
PMID 34495190WHAT IT FOUND
qSOFA ≥2 was associated with sepsis, septic shock, and hospital death in 122 emergency patients; SIRS >2 was associated with sepsis and septic shock.
Key findings
01qSOFA ≥2 was associated with hospital death (RR 3.30; CI 95% 1.59 - 6.87; p<0.001), sepsis (RR 2.46; CI 95% 1.75 - 3.45; p<0.001), and septic shock (RR 3.77; CI 95% 2.03 - 7.02; p<0.001).
02SIRS >2 was associated with sepsis (RR 1,916; CI 95% 1.10 - 3.31; p<0.004) and septic shock (RR 3.46; CI 95% 1.16 - 10.33; p<0.005).
03For predicting sepsis, qSOFA ≥2 had sensitivity 66% and specificity 86%; SIRS had sensitivity 87.5% and specificity 34.7%; comparing the scores showed no statistical difference (p = 0.3327).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and used electronic medical records from a single emergency service, so findings may not apply to other settings. Patients were excluded if the nurse did not complete qSOFA or if SIRS data were missing, which may have selected a sample with better documentation. The paper did not compare qSOFA or SIRS with other scores such as MEWS. qSOFA was designed as an alert tool for early assessment, not as a diagnostic test for sepsis. Some confidence intervals were wide, especially for septic shock and mortality associations.
The easy way to misread this
Do not use qSOFA ≥2 to diagnose sepsis. It had sensitivity 66% and specificity 86% for sepsis, and the paper describes it as an alert tool for early assessment, not a diagnostic test.