Scoring systems for early detection of sepsis on the ward

Sepsis is one of the most common causes of death in Norwegian hospitals. The condition is often overlooked with treatment being delayed. Scoring systems to detect patients with sepsis have mostly been studied in emergency departments and more rarely on wards. The objective of this study was to investigate the ability of various clinical scoring systems to identify sepsis in patients on wards.

The ability of the scoring systems SIRS (Systemic Inflammatory Response Syndrome), qSOFA (quick Sequential Organ Failure Assessment) and NEWS2 (National Early Warning Score 2) to identify patients with sepsis was compared in a study of adult patients with clinically suspected severe infection on wards at Haukeland University Hospital in the period March-December 2019. The diagnosis of sepsis was made based on an increase in SOFA (Sequential Organ Failure Assessment) score of 2 or more in the first 24 hours after inclusion.

89 patients with suspected new onset of severe infection were identified. Sepsis was diagnosed in 55 of these patients. SIRS had a sensitivity of 82 % and a specificity of 6 % in diagnosing sepsis, qSOFA had a sensitivity of 20 % and a specificity of 97 %, while NEWS2 with a threshold of an aggregate score ≥ 5 and/or 3 in a single parameter had a sensitivity of 96 % and a specificity of 59 %. Oxygen saturation with a threshold of 95 % was the most sensitive measurement for sepsis.

NEWS2 was better suited than qSOFA and SIRS for early detection of sepsis on wards.