Abstract
To allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. Second, we aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis. RETTS combines vital signs with symptoms for risk stratification. We retrospectively analysed data from two prospective, observational, multicentre cohorts of patients from studies of biomarkers in ED. A candidate risk stratification score called Sepsis Heparin-binding protein-based Early Warning Score (SHEWS) was constructed using the Least Absolute Shrinkage and Selector Operator (LASSO) method. SHEWS and RETTS were compared to National Early Warning Score 2 (NEWS2) for infection-related organ dysfunction, intensive care or death within the first 72h after admission (i.e. sepsis). 506 patients with a diagnosed infection constituted cohort A, in which SHEWS was derived and RETTS was validated. 435 patients constituted cohort B of whom 184 had a diagnosed infection where both scores were validated. In both cohorts (A and B), AUC for infection-related organ dysfunction, intensive care or death was higher for NEWS2, 0.80 (95% CI 0.76-0.84) and 0.69 (95% CI 0.63-0.74), than RETTS, 0.74 (95% CI 0.70-0.79) and 0.55 (95% CI 0.49-0.60), p = 0.05 and p <0.01, respectively. SHEWS had the highest AUC, 0.73 (95% CI 0.68-0.79) p = 0.32 in cohort B. Even with a statistical approach, we could not construct better risk stratification scores for sepsis than NEWS2. RETTS was inferior to NEWS2 for screening for sepsis.
Highlights
Sepsis is a medical emergency, requiring early recognition and care
506 patients with a diagnosed infection constituted cohort A, in which Sepsis Heparin-binding protein-based Early Warning Score (SHEWS) was derived and Rapid Emergency Triage and Treatment System (RETTS) was validated. 435 patients constituted cohort B of whom 184 had a diagnosed infection where both scores were validated. In both cohorts (A and B), Area Under receiver operating characteristic Curve (AUC) for infectionrelated organ dysfunction, intensive care or death was higher for National Early Warning Score 2 (NEWS2), 0.80 and 0.69, than RETTS, 0.74 and 0.55, p = 0.05 and p
SHEWS had the highest AUC, 0.73 p = 0.32 in cohort B
Summary
Sepsis is a medical emergency, requiring early recognition and care. Its clinical features can vary and be vague and difficult to detect. The National Early Warning Score 2 (NEWS2) is a modification of National Early Warning Score (NEWS) and is a risk stratification score for the probability of clinical deterioration of for example development of sepsis [4]. NEWS2 has the best accuracy for sepsis detection of the commonly used risk stratification scores, we have previously shown that a substantial portion of patients with sepsis goes undetected with a cut-off of NEWS2 5 [5]. To allow early identification of patients at risk of sepsis in the emergency department (ED), a variety of risk stratification scores and/or triage systems are used. The first aim of this study was to develop a risk stratification score for sepsis based upon vital signs and biomarkers using a statistical approach. We aimed to validate the Rapid Emergency Triage and Treatment System (RETTS) for sepsis.
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