Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection: a prospective cohort study

Ulrika M Wallgren,Lisa Kurland,Jan Sjölin,Hans Järnbert-Pettersson

doi:10.1186/s13049-021-00958-3

Abstract

BackgroundThere is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment.MethodsProspective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong’s test.ResultsThe prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87–0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39–0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75–0.77) was similar.ConclusionsThe results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation.Trial registration: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597.

Highlights

There is little evidence of which sepsis screening tool to use in the ambulance setting
The results of the current study indicated no major difference with respect to sepsis identification when based on comparisons of the area under the receiver operating curve (AUC) of rapid emergency triage and treatment system (RETTS) orange, National Early Warning Score 2 (NEWS2) and the Predict Sepsis screening tools
Strengths and limitations of the current study This is the first prospective study to compare the performance of NEWS2 and RETTS in the ambulance setting for the identification of sepsis, which is considered a strength of the study

Summary

Introduction

There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. Neither the National Early Warning score (NEWS2) [20] nor the rapid emergency triage and treatment system (RETTS) [21, 22], an early warning score and a triage system respectively [20], are initially designed to identify sepsis. Neither NEWS2 nor RETTS have previously been validated with respect to sepsis identification in the ambulance

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