To predict poor outcomes among patients with susceptible sepsis during triage, institution priorities should drive score selection, balancing sensitivity and specificity, when determining risk stratification, according to a study published in the Journal of Hospital Medicine. Researchers compared the abilities of identifying high-risk patients of the quick Sequential Organ Failure Assessment (qSOFA), the National Early Warning System (NEWS2), and the Shock Index. They found that the qSOFA was highly specific and the NEWS2 was the most sensitive for ruling out patients at high risk. Performance of the Shock Index fell between qSOFA and NEWS2 and could be considered because it is easy to implement. The retrospective cohort study consisted of adults presenting to an academic emergency department (ED) from June 2012 to December 2018 who had blood cultures and intravenous antibiotics within 24 hours. Patients were considered positive at qSOFA scores of 2 or greater, Shock Index scores greater than 0.7, or NEWS2 scores of 5 or greater. Researchers calculated test characteristics and area under the receiver operating characteristics curves (AUROCs) to predict in-hospital mortality and ED-to-ICU admission. Included were more than 23 million patients; 1,921(8.1%) were qSOFA-positive, 4,273 (17.9%) Shock Index-positive, and 11,832 (49.6%) NEWS2- positive. There were 1,427 (6.0%) deaths and 3,149 (13.2%) ED-to-ICU admissions in the sample. NEWS2 had the highest sensitivity for in-hospital mortality (76.0%) and ED-to-ICU admission (78.9%), whereas qSOFA had the highest specificity for in-hospital mortality (93.4%) and ED-to-ICU admission (95.2%) and Shock Index exhibited the highest AUROC for in-hospital mortality (0.648) and ED-to-ICU admission (0.680).
