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Modified Sequential Organ Failure Assessment score for predicting mortality in emergency department patients with
Anna Vosseteig1,2, Tiffany Huang3, Peter Jones1,3
1Adult Emergency Department, Auckland City Hospital, Auckland, New Zealand.
Objective:
Several scoring systems have been proposed for EDs to identify patients at increased risk of mortality from sepsis. The modified Sequential Organ Failure Assessment (mSOFA) score, proposed in 2019, demonstrated a high negative predictive value. We aimed to validate mSOFA and compare its accuracy for predicting 30-day mortality to the simple bedside score, quick SOFA (qSOFA).
Methods:
Over 1 month in 2018, consecutive patients with suspected sepsis were prospectively identified. A retrospective chart review was conducted to calculate both the mSOFA and qSOFA scores for these patients. The primary outcome was 30-day mortality.
Results:
There were 252 patients with suspected sepsis identified over the study period. Thirty-day mortality was 13/39 (33.3%) for those with a positive mSOFA and 15/211 (7.1%) for those with a negative mSOFA score. Sensitivity was 46.4% (95% confidence interval [CI] 27.5-66.1%), specificity 88.3% (95% CI 83.3-92.2%), positive likelihood ratio 3.96 (95% CI 2.32-6.78), negative likelihood ratio 0.61 (95% CI 0.43-0.86). The area under the curve (AUC) was 0.74 (95% CI 0.64-0.85). qSOFA sensitivity was 39.3% (95% CI 21.5-59.4%), specificity 91.9% (95% CI 87.5-95.1%), positive likelihood ratio 4.85 (95% CI 2.56-9.18) and negative likelihood ratio 0.66 (95% CI 0.49-0.89). The AUC for qSOFA was 0.81 (95% CI 0.73-0.88). The difference in the AUC was -0.07 (95% CI -0.18 to 0.05), P = 0.25.
Conclusions:
In the present study, neither mSOFA nor qSOFA was adequately sensitive for predicting 30-day mortality, although both scores were highly specific and their overall accuracy was similar. The added complexity of the mSOFA without a significant increase in discriminative ability makes it unlikely to replace qSOFA in the ED setting.
Insights
Neither the modified SOFA (mSOFA) score nor the quick SOFA (qSOFA) score adequately predicted 30-day sepsis mortality in this study. Both scores showed high specificity but similar overall accuracy, suggesting mSOFA may not replace qSOFA in emergency departments.
Area of Science:
- Critical Care Medicine
- Emergency Medicine
- Infectious Diseases
Background:
- Sepsis poses a significant mortality risk in emergency departments (EDs).
- Accurate risk stratification is crucial for timely intervention.
- Existing scoring systems aim to identify high-risk sepsis patients.
Purpose of the Study:
- To validate the modified Sequential Organ Failure Assessment (mSOFA) score.
- To compare the predictive accuracy of mSOFA against the quick SOFA (qSOFA) score for 30-day sepsis-related mortality.
- To assess the utility of mSOFA in the ED setting.
Main Methods:
- Prospective identification of consecutive patients with suspected sepsis over one month.
- Retrospective calculation of mSOFA and qSOFA scores for each patient.
- Primary outcome measured was 30-day mortality.
Main Results:
- The study included 252 patients with suspected sepsis.
- Neither mSOFA (AUC 0.74) nor qSOFA (AUC 0.81) demonstrated high sensitivity for predicting 30-day mortality.
- Both scores exhibited high specificity, with comparable overall accuracy (P=0.25).
Conclusions:
- The mSOFA score did not show significantly improved discriminative ability compared to qSOFA.
- The added complexity of mSOFA does not justify its adoption over qSOFA in EDs.
- Neither score is sufficiently sensitive for reliable prediction of 30-day sepsis mortality.
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