Prognostic accuracy of screening tools for clinical deterioration in adults with suspected sepsis in northeastern Thailand: a cohort validation study

Abstract

Abstract Background We sought to assess the performance of commonly used clinical scoring systems to predict imminent clinical deterioration in patients hospitalized with suspected infection in rural Thailand. Methods Patients with suspected infection were prospectively enrolled within 24 hours of admission to a referral hospital in northeastern Thailand between 2013 and 2017. In patients not requiring intensive medical interventions, multiple enrollment scores were calculated including the National Early Warning Score (NEWS), the Modified Early Warning Score (MEWS), Between the Flags (BTF) and the quick Sequential Organ Failure Assessment (qSOFA) score. Scores were tested for predictive accuracy of clinical deterioration, defined as a new requirement of mechanical ventilation, vasoactive medications, ICU admission, and/or death approximately 1 day after enrollment. The association of each score with clinical deterioration was evaluated by logistic regression and discrimination was assessed by generating areas under the receiver operating characteristic curve (AUROC). Results 2680/4989 enrolled patients met criteria for secondary analysis and 100/2680 (4%) experienced clinical deterioration within 1 day following enrollment. NEWS had the highest discrimination for predicting clinical deterioration (AUROC 0.78, 95% confidence interval (CI) 0.74-0.83) compared to MEWS (AUROC 0.67, 95% CI 0.63-0.73, p<0.0001), qSOFA (AUROC 0.65, 95% CI 0.60-0.70, p<0.0001), and BTF (AUROC 0.69, 95% CI 0.64-0.75, p<0.001). NEWS ≥ 5 yielded optimal sensitivity and specificity for clinical deterioration prediction. Conclusion In patients hospitalized with suspected infection in a resource-limited setting in Southeast Asia, NEWS can identify patients at risk of imminent clinical deterioration with greater accuracy than other clinical scoring systems.