Sensitivity and Specificity of a quick Sequential [Sepsis‐Related] Organ Failure Assessment Sepsis Screening Tool

2021 ◽  
Author(s):  
Laura Alberto ◽  
Andrea P. Marshall ◽  
Rachel M. Walker ◽  
Fernando Pálizas ◽  
Leanne M. Aitken
Keyword(s):  
Organ Failure ◽  
Sensitivity And Specificity ◽  
Screening Tool ◽  
Failure Assessment ◽  
Sepsis Screening

scholarly journals Implementing a quick Sequential (Sepsis-Related) Organ Failure Assessment sepsis screening tool: an interrupted times series study

2020 ◽  
Vol 32 (6) ◽  
pp. 388-395
Author(s):  
Laura Alberto ◽  
Leanne M Aitken ◽  
Rachel M Walker ◽  
Fernando Pálizas ◽  
Andrea P Marshall
Keyword(s):  
Organ Failure ◽  
Prospective Data ◽  
Suspected Infection ◽  
Times Series ◽  
Failure Assessment ◽  
Screening Procedures ◽  
Sepsis Screening ◽  
Hospital Wards ◽  
Series Study ◽  
Developing Settings

Abstract Objective The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-h bundle was also evaluated. Design Interrupted times series with prospective data collection. Setting Five hospital wards in a developing nation, Argentina. Participants A total of 1151 patients (≥18 years) recruited within 24–48 h of hospital admission. Intervention The qSOFA-based SS tool and the 6-h bundle. Main outcome measures The primary outcome was the timing of implementation of the first 6-h bundle element. Secondary outcomes were related to the adherence to the screening procedures. Results Of 1151 patients, 145 (12.6%) met the qSOFA-based SS tool criteria, among them intervention (39/64) patients received the first 6-h bundle element earlier (median 8 h; 95% confidence interval (CI): 0.1–16) than baseline (48/81) patients (median 22 h; 95% CI: 3–41); these times, however, did not differ significantly (P = 0.525). Overall, 47 (4.1%) patients had sepsis; intervention patients (18/25) received the first 6-h bundle element sooner (median 5 h; 95% CI: 4–6) than baseline patients (15/22) did (median 12 h; 95% CI: 0–33); however, times were not significantly different (P = 0.470). While intervention patients were screened regularly, only one-third of patients who required sepsis alerts had them activated. Conclusion The implementation of the qSOFA-based SS tool resulted in early, but not significantly improved, provision of 6-h bundle care. Screening procedures were regularly conducted, but sepsis alerts rarely activated. Further research is needed to better understand the implementation of sepsis care in developing settings.

scholarly journals Comparison of Proposed Modified and Original Sequential Organ Failure Assessment Scores in Predicting ICU Mortality: A Prospective, Observational, Follow-Up Study

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Afshin Gholipour Baradari ◽  
Hassan Sharifi ◽  
Abolfazl Firouzian ◽  
Maryam Daneshiyan ◽  
Mohsen Aarabi ◽  
...  
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Diagnostic Odds Ratio ◽  
Icu Mortality ◽  
Icu Admission ◽  
Assessment Scores ◽  
Failure Assessment

Background. The sequential organ failure assessment (SOFA) score has been recommended to triage critically ill patients in the intensive care unit (ICU). This study aimed to compare the performance of our proposed MSOFA and original SOFA scores in predicting ICU mortality. Methods. This prospective observational study was conducted on 250 patients admitted to the ICU. Both tools scores were calculated at the beginning, 24 hours of ICU admission, and 48 hours of ICU admission. Diagnostic odds ratio and receiver operating characteristic (ROC) curve were used to compare the two scores. Results. MSOFA and SOFA predicted mortality similarly with an area under the ROC curve of 0.837, 0.992, and 0.977 for MSOFA 1, MSOFA 2, and MSOFA 3, respectively, and 0.857, 0.988, and 0.988 for SOFA 1, SOFA 2, and SOFA 3, respectively. The sensitivity and specificity of MSOFA 1 in cut-off point 8 were 82.9% and 68.4%, respectively, MSOFA 2 in cut-off point 9.5 were 94.7% and 97.1%, respectively, and MSOFA 3 in cut-off point of 9.3 were 97.4% and 93.1%, respectively. There was a significant positive correlation between the MSOFA 1 and the SOFA 1 (r: 0.942), 24 hours (r: 0.972), and 48 hours (r: 0.960). Conclusion. The proposed MSOFA and the SOFA scores had high diagnostic accuracy, sensitivity, and specificity for predicting mortality.

scholarly journals Age-adjusted quick Sequential Organ Failure Assessment score for predicting mortality and disease severity in children with infection: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sohyun Eun ◽  
Haemin Kim ◽  
Ha Yan Kim ◽  
Myeongjee Lee ◽  
Go Eun Bae ◽  
...  
Keyword(s):  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Disease Severity ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Cochrane Library ◽  
Summary Receiver Operating Characteristic ◽  
Assessment Score ◽  
Failure Assessment

AbstractWe assessed the diagnostic accuracy of the age-adjusted quick Sequential Organ Failure Assessment score (qSOFA) for predicting mortality and disease severity in pediatric patients with suspected or confirmed infection. We conducted a systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science. Eleven studies with a total of 172,569 patients were included in the meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio of the age-adjusted qSOFA for predicting mortality and disease severity were 0.69 (95% confidence interval [CI] 0.53–0.81), 0.71 (95% CI 0.36–0.91), and 6.57 (95% CI 4.46–9.67), respectively. The area under the summary receiver-operating characteristic curve was 0.733. The pooled sensitivity and specificity for predicting mortality were 0.73 (95% CI 0.66–0.79) and 0.63 (95% CI 0.21–0.92), respectively. The pooled sensitivity and specificity for predicting disease severity were 0.73 (95% CI 0.21–0.97) and 0.72 (95% CI 0.11–0.98), respectively. The performance of the age-adjusted qSOFA for predicting mortality and disease severity was better in emergency department patients than in intensive care unit patients. The age-adjusted qSOFA has moderate predictive power and can help in rapidly identifying at-risk children, but its utility may be limited by its insufficient sensitivity.

scholarly journals Development of a Simple Sequential Organ Failure Assessment Score for Risk Assessment of Emergency Department Patients With Sepsis

2017 ◽  
Vol 35 (3) ◽  
pp. 270-278 ◽  
Author(s):  
Faheem W. Guirgis ◽  
Michael A. Puskarich ◽  
Carmen Smotherman ◽  
Sarah A. Sterling ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sensitivity And Specificity ◽  
Sofa Score ◽  
External Validation ◽  
Predictive Ability ◽  
Failure Assessment ◽  
Validation Set

Objectives: Sepsis-3 recommends using the quick Sequential Organ Failure Assessment (qSOFA) score followed by SOFA score for sepsis evaluation. The SOFA is complex and unfamiliar to most emergency physicians, while qSOFA is insensitive for sepsis screening and may result in missed cases of sepsis. The objective of this study was to devise an easy-to-use simple SOFA score for use in the emergency department (ED). Methods: Retrospective study of ED patients with sepsis with in-hospital mortality as the primary outcome. A simple SOFA score was derived and validated and compared with SOFA and qSOFA. Results: A total of 3297 patients with sepsis were included, and in-hospital mortality was 10.1%. Simple SOFA had a sensitivity and specificity of 88% and 44% in the derivation set and 93% and 44% in the validation set for in-hospital mortality, respectively. The sensitivity and specificity of qSOFA was 38% and 86% and for SOFA was 90% and 50%, respectively. There were 2760 (84%) of 3297 qSOFA-negative (<2) patients. In this group, simple SOFA had a sensitivity and specificity of 86% and 48% in the derivation set and 91% and 48% in the validation set, respectively. Sequential Organ Failure Assessment was 86% sensitive and 57% specific in qSOFA-negative patients. For all encounters, the areas under the receiver–operator characteristic curves (AUROC) were 0.82 for SOFA, 0.78 (derivation) and 0.82 (validation) for simple SOFA, and 0.68 for qSOFA. In qSOFA-negative patients, the AUROCs were 0.80 for SOFA and 0.76 (derivation) and 0.82 (validation) for simple SOFA. Conclusions: Simple SOFA demonstrates similar predictive ability for in-hospital mortality from sepsis compared to SOFA. External validation of these findings is indicated.

111 Burn Sepsis Screening Tool to Facilitate Diagnosis of Burn Sepsis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S74-S75
Author(s):  
Kaitlyn Libraro ◽  
Palmer Bessey ◽  
Jamie Heffernan ◽  
James Gallagher
Keyword(s):  
Critically Ill ◽  
Screening Tool ◽  
Burn Injury ◽  
Clinical Signs ◽  
Case Fatality ◽  
Inhalation Injury ◽  
Clinical Feature ◽  
Sepsis Diagnosis ◽  
Acute Decompensation ◽  
Sepsis Screening

Abstract Introduction Sepsis following critical burn injury is an ominous development that can lead to death. Most patients will manifest a systemic inflammatory response syndrome (SIRS), even without being septic. This may obscure the clinical recognition of developing sepsis and delay the initiation of effective treatment. We developed a burn sepsis screening tool (BSST) to facilitate the recognition of developing burn sepsis. The purpose of this study was to review the utility of that tool. Methods The BSST was based on several clinical signs, laboratory values, and changes in physiologic support modalities associated with sepsis. It consisted of nine parameters that could be scored as indicating or not indicating sepsis or not applicable. If three were positive, the patient was identified as septic, and a search for a septic source was undertaken and treatment initiated. The BSST was completed on patients judged to be critically ill during morning rounds over a period of nine months. The values were transcribed into a secure web database and analyzed using SAS 9.4. Results There were 593 individual encounters on 31 critically ill patients with burns and/or inhalation injury for which the BSST was completed. The mean age of the patients was 57 ± 4 years (Mean ± SEM), and the burn size was 24 ± 15 % TBSA. Eleven patients were women (36%) and 7 patients had inhalation injury (23%). The expected case fatality was 21 - 30% depending on the statistical model used. Six patients (19%) died. The length of stay was 64 ± 10 days and ranged from 3 to 267 days. A patient was judged to be septic in only 45 of the daily encounters (8.0 % ± 1.1). There were 21 instances of a new septic event made in 12 patients. Episode of sepsis separated by at least 5 days of no sepsis, were considered to be a new septic event. There was a substantial amount of data that was missing or not applicable. There were no significant differences in the septic parameters on days with new sepsis diagnosis when compared to the day prior, or compared to all encounters in patients that were never septic. Patients deteriorated acutely between BSST completions on only two occasions and both were stabilized. Conclusions The BSST was used consistently to help evaluate the daily status of critically ill burn injured patients. The expected case fatality of the group was moderately high, based on statistical models derived from the ABA Burn Registry. The observed outcome was as good as or better than predicted. Acute decompensation was rare. The BSST added daily administrative work to rounds, and the data recorded were often incomplete. Although the BSST did not demonstrate any single clinical feature that identified the transition from SIRS to sepsis, it did add structure and rigor to daily rounds. That contributed to the effectiveness of rounds, and it may have been responsible, in part, for the favorable outcomes.

Sepsis nach elektiver Septumplastik und Nasenmuschelverkleinerung

2019 ◽  
Vol 98 (08) ◽  
pp. 571-574
Author(s):  
Katharina Stölzel ◽  
Lichun Zhang ◽  
Tordis Borowski ◽  
Heidi Olze ◽  
Tim Schroeder ◽  
...  
Keyword(s):  
Organ Failure ◽  
Assessment Score ◽  
Failure Assessment ◽  
Qsofa Score

FallberichtEin 20-jähriger adipöser Patient stellte sich im August 2018 in einer auswärtigen Klinik zur Septumplastik und Muschelverkleinerung bei Septumdeviation und Muschelhyperplasie ohne relevante Vorerkrankungen vor. Intraoperativ war keine Antibiotikagabe erfolgt. Postoperativ wurde der Patient zur weiteren Betreuung mit Doyle-Splinten und Gelaspon® auf die Normalstation verlegt. Es war Hochsommer und die Krankenzimmertemperatur bei ausgefallener Klimaanlage sehr hoch. Wie erst später fremdanamnestisch bekannt wurde, hatte der Patient eine bereits vor stationärer Aufnahme mehrere Tage bestehende, aber nicht mitgeteilte Enteritis. Am Morgen des ersten postoperativen Tages wies der Patient Zeichen der Sepsis auf: arterielle Hypotonie, Tachykardie, Tachypnoe und Desorientierung (= quick Sepsis – related organ failure assessment Score [qSOFA Score] = positiv). Es erfolgte die Gabe von Kristalloiden und bei Schwellung des Gesichtes die Entfernung der Doyle-Splinte. Ungeachtet dessen kam es zur progredienten Verschlechterung und Entwicklung eines schweren Schocks, so dass mit der Gabe von Vasopressoren begonnen wurde. Bei zusätzlich beginnender respiratorischer Erschöpfung wurde die Indikation zur Intubation gestellt. Während der Intubation kam es zur Aspiration. Zur weiteren intensivmedizinischen Versorgung erfolgte aus kapazitären Gründen die Verlegung auf die interdisziplinäre internistische Intensivstation unserer Klinik mit zunächst unklarem Infektfokus. Bei Übernahme war der Patient intubiert und beatmet (CPAP PEEP 9 mbar, Druckunterstützung 16 mbar, FiO2 0,8) und hoch katecholaminpflichtig (Noradrenalin 1 µg/kg/min, Epinephrin 0,2 µg/kg/min).

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