Diagnostic Performance of Sepsis Scores in the Emergency Department: A Retrospective Study
Article Sidebar
Emergency Department,
SOFA Score,
qSOFA,
SIRS,
Diagnostic Accuracy
Main Article Content
Abstract
This study aimed to evaluate and compare the diagnostic performance of three commonly used sepsis scoring systems SIRS, SOFA, and qSOFA in patients presenting to the emergency department. A retrospective diagnostic accuracy study was conducted using data from 800 adult patients who presented to a tertiary hospital emergency department with suspected infection between January 2023 and December 2024. Sepsis was defined according to Sepsis3 criteria. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC) were calculated for each scoring system. SOFA demonstrated the highest diagnostic performance (AUC: 0.87), followed by qSOFA (AUC: 0.74) and SIRS (AUC: 0.71). SIRS had the highest sensitivity (84%) but lowest specificity (55%). qSOFA showed the highest specificity (88%) but lowest sensitivity (50%). SOFA achieved balanced sensitivity (80%) and specificity (78%). Subgroup analysis showed that SOFA was superior in predicting ICU admission and mortality, while qSOFA was effective for identifying critically ill patients. Among the evaluated scoring systems, SOFA provides the best diagnostic accuracy for sepsis in the emergency setting. While qSOFA is useful for identifying high-risk patients quickly, its low sensitivity limits its standalone utility. SIRS remains highly sensitive but lacks specificity. These findings can support clinical decisionmaking and triage in emergency care.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Delano, M. J., & Ward, P. A. (2016). The immune system's role in sepsis progression, resolution, and long‐term outcome. Immunological reviews, 274(1), 330-353. https://doi.org/10.1111/imr.12499
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., ... & Levy, M. (2021). Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Critical care medicine, 49(11), e1063-e1143. https://doi.org/10.1097/CCM.0000000000005337
Freund, Y., Lemachatti, N., Krastinova, E., Van Laer, M., Claessens, Y. E., Avondo, A., ... & Beaune, S. (2017). Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. Jama, 317(3), 301-308. https://doi.org/10.1001/jama.2016.20329
Harley, A., Johnston, A. N. B., Denny, K. J., Keijzers, G., Crilly, J., & Massey, D. (2019). Emergency nurses’ knowledge and understanding of their role in recognising and responding to patients with sepsis: A qualitative study. International emergency nursing, 43, 106-112. https://doi.org/10.1016/j.ienj.2019.01.005
Jiang, J., Yang, J., Mei, J., Jin, Y., & Lu, Y. (2018). Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: A meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 26(1), 56. https://doi.org/10.1186/s13049-018-0527-9
Khwannimit, B., Bhurayanontachai, R., & Vattanavanit, V. (2018). Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. Journal of critical care, 44, 156-160. https://doi.org/10.1016/j.jcrc.2017.10.023
Raith, E. P., Udy, A. A., Bailey, M., McGloughlin, S., MacIsaac, C., Bellomo, R., & Pilcher, D. V. (2017). Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. Jama, 317(3), 290-300. https://doi.org/10.1001/jama.2016.20328
Rodriguez, R. M., Greenwood, J. C., Nuckton, T. J., Darger, B., Shofer, F. S., Troeger, D., ... & Baumann, B. M. (2018). Comparison of qSOFA with current emergency department tools for screening of patients with sepsis for critical illness. Emergency Medicine Journal, 35(6), 350-356. https://doi.org/10.1136/emermed-2017-207383
Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in developmental disabilities, 24(5), 391-404. https://doi.org/10.1016/S08914222(03)00055-6
Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., ... & Naghavi, M. (2020). Global, regional, and national sepsis incidence and mortality, 1990– 2017: analysis for the Global Burden of Disease Study. The Lancet, 395(10219), 200-211. https://doi.org/10.1016/S0140-6736(19)32989-7
Serafim, R., Gomes, J. A., Salluh, J., & Póvoa, P. (2018). A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest, 153(3), 646-655. https://doi.org/10.1016/j.chest.2017.12.015
Seymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., ... & Angus, D. C. (2016). Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama, 315(8), 762-774.
https://doi.org/10.1001/jama.2016.0288
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... & Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama, 315(8), 801-810. https://doi.org/10.1001/jama.2016.0287
Song, J. U., Sin, C. K., Park, H. K., Shim, S. R., & Lee, J. (2018). Performance of the quick sequential (sepsis-related) organ failure assessment score as a prognostic tool in infected patients outside the intensive care unit: A systematic review and meta-analysis. Critical Care, 22(1), 28. https://doi.org/10.1186/s13054-018-1952-x
Sygitowicz, G., & Sitkiewicz, D. (2021). Molecular mechanisms of organ damage in sepsis: an overview. Brazilian Journal of Infectious Diseases, 24, 552-560. https://doi.org/10.1016/j.bjid.2020.09.004
Williams, J. M., Greenslade, J. H., McKenzie, J. V., Chu, K., Brown, A. F., & Lipman, J. (2017). Systemic inflammatory response syndrome, quick sequential organ function assessment, and organ dysfunction: insights from a prospective database of ED patients with infection. Chest, 151(3), 586-596. https://doi.org/10.1016/j.chest.2016.10.05