Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital
Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential n...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-07-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/14/7/708 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background: Early identification of sepsis is critical for improving outcomes, particularly in low-resource emergency settings. In Thai community hospitals, where physicians may not always be available, triage is often nurse-led. Selecting accurate and practical sepsis screening tools is essential not only for timely clinical decision-making but also for timely diagnosis and promoting appropriate antibiotic use. Methods: This cross-sectional study analyzed 475 adult patients with suspected sepsis who presented to the emergency department of a Thai community hospital, using retrospective data from January 2021 to December 2022. Six screening tools were evaluated: Systemic Inflammatory Response Syndrome (SIRS), Quick Sequential Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), National Early Warning Score version 2 (NEWS2), and Search Out Severity (SOS). Diagnostic accuracy was assessed using International Classification of Diseases, Tenth Revision (ICD-10) codes as the reference standard. Performance metrics included sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic (AUROC) curve, all reported with 95% confidence intervals. Results: SIRS had the highest sensitivity (84%), while qSOFA demonstrated the highest specificity (91%). NEWS2, NEWS, and MEWS showed moderate and balanced diagnostic accuracy. SOS also demonstrated moderate accuracy. Conclusions: A two-step screening approach—using SIRS for initial triage followed by NEWS2 for confirmation—is recommended. This strategy enhances nurse-led screening and optimizes limited resources in emergency care. Early sepsis detection through accurate screening tools constitutes a feasible public health intervention to support appropriate antibiotic use and mitigate antimicrobial resistance, especially in resource-limited community hospital settings. |
|---|---|
| ISSN: | 2079-6382 |