1. Shapiro criteria and qSOFA scores significantly predicted sepsis-related mortality in bacteremic patients.
2. Model performance measures did not strongly support the independent use of sepsis criteria to screen for bacteremia in emergency departments.
Evidence Level Rating: 2 (Good)
While bacteremia associated with sepsis is associated with high mortality rates, prompt identification of sepsis and initiation of antimicrobials has essential survival benefits. Several sepsis scores have been defined, including SIRS, qSOFA, CEC SEPSIS KILLS and Shapiro criteria with varying performance measures (e.g., sensitivity and specificity). A retrospective age-matched cohort study included 502 adult ED patients with true positive or negative blood cultures. The primary outcome was to determine the sensitivity and specificity of these sepsis criteria within the cohort, compared to age-matched non-bacteremic individuals. The modified Shapiro criteria had the highest sensitivity (88%) and modest specificity (37.85%) while qSOFA had the highest specificity (83.67%) and poor sensitivity (19.82%). CEC SEPSIS pathway sensitivity was 70.1% with specificity of 71.1%, and SEPSIS KILLS was activated on only 14% of bacteremic patients. Proportionately more patients who later died of sepsis-related mortality were identified by the Shapiro criteria (OR 0.23 [95% CI 0.05 ≤ OR ≤ 0.98]; p = 0.03) and qSOFA score (OR 0.36 [95%CI 0.14 ≤ OR ≤ 0.94]; p=0.03). Overall, results suggest that individual sepsis scores should not be used as stand-alone tools when evaluating patients in emergency departments for bacteremia. Potential confounds were differing comorbidities in age-matched patients and the transient potential in bacteremia for false negative blood culture results. Future research is required.
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