qSOFA vs SIRS vs NEWS vs NEWS2 in the emergency department: A prospective study
Refereed conference paper presented and published in conference proceedings

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AbstractBackground: Sepsis is the primary cause of death from infection worldwide. In 2016, Sepsis-3, a new clinical concept termed ‘Quick Sepsis-Related Organ Failure Assessment’ (qSOFA) was introduced to identify high risk patients with suspected infection. The present study aimed to validate qSOFA in an emergency department in Hong Kong. Furthermore, we compared the prognostic value of qSOFA and the previous criteria- Systemic Inflammatory Response Syndrome (SIRS)- as well as a commonly used early warning score, National Early Warning Score (NEWS) and its updated version National Early Warning Score (NEWS) 2.
Methods: This is a single-centre, prospective study conducted in the ED of Prince of Wales Hospital, HK between July 2016 and June 2017, triaged as category 2 (Emergency) and 3 (Urgent) were recruited. All variables for calculating qSOFA, SIRS, NEWS and NEWS2 were collected. The primary outcome measure was 7-day mortality. Venous lactate was also measured to investigate whether lactate levels provide additional value for the prediction of 7-day mortality. The prognostic value of the different scores to predict 7-day mortality was studied. Receiver Operating Characteristic analysis were performed to determine the Area Under the Curve (AUC), sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio for qSOFA≥2, SIRS≥2, NEWS≥5 and NEWS2≥5.
Results: Of 1253 patients recruited, median age was 72 years (IQR: 59-84); 638 (50.9%) were male. Overall 7-day mortality was 2.6%. The AUC for prediction of 7-day mortality for qSOFA≥2, SIRS≥2, NEWS≥5 and NEWS2≥5 were 0.57 (95%CI 0.54-0.60), 0.70 (95%CI 0.67-0.72), 0.68 (95%CI 0.66-0.71) and 0.68 (95%CI 0.66-0.71) respectively. NEWS≥5 (p=0.014), NEWS2≥5 (p=0.014) and SIRS≥2 (p=0.012) performed better than qSOFA≥2 to predict 7-day mortality in ED patients.
Conclusion: Among emergency and urgent patients presenting to the ED, NEWS/NEWS2 and SIRS perform better than qSOFA to predict 7-day mortality
All Author(s) ListLing Yan LEUNG, Ronson Sze Long LO, Kevin Kei Ching HUNG, Chun Yu YEUNG, Suet Yi CHAN, Colin A. GRAHAM
Name of ConferenceThe First Cochrane Hong Kong Symposium
Start Date of Conference23/05/2019
End Date of Conference24/05/2019
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
Proceedings TitleThe First Cochrane Hong Kong Symposium,
Pages55 - 55
LanguagesEnglish-United Kingdom

Last updated on 2019-10-12 at 16:25