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...
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MDPI AG
2025-07-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/14/7/708 |
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| author | Wisanu Wanlumkhao Duangduan Rattanamongkolgul Chatchai Ekpanyaskul |
| author_facet | Wisanu Wanlumkhao Duangduan Rattanamongkolgul Chatchai Ekpanyaskul |
| author_sort | Wisanu Wanlumkhao |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-82faa47126e7497bb45438ca368331fa |
| institution | DOAJ |
| issn | 2079-6382 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj-art-82faa47126e7497bb45438ca368331fa2025-08-20T02:45:48ZengMDPI AGAntibiotics2079-63822025-07-0114770810.3390/antibiotics14070708Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community HospitalWisanu Wanlumkhao0Duangduan Rattanamongkolgul1Chatchai Ekpanyaskul2Department of Adult and Gerontological Nursing, Faculty of Nursing, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, ThailandDepartment of Adult and Gerontological Nursing, Faculty of Nursing, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, ThailandDepartment of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, ThailandBackground: 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.https://www.mdpi.com/2079-6382/14/7/708sepsis screeningearly warning scoresantimicrobial resistancecommunity hospitallow-resource settingshealthcare quality |
| spellingShingle | Wisanu Wanlumkhao Duangduan Rattanamongkolgul Chatchai Ekpanyaskul Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital Antibiotics sepsis screening early warning scores antimicrobial resistance community hospital low-resource settings healthcare quality |
| title | Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital |
| title_full | Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital |
| title_fullStr | Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital |
| title_full_unstemmed | Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital |
| title_short | Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital |
| title_sort | performance of early sepsis screening tools for timely diagnosis and antibiotic stewardship in a resource limited thai community hospital |
| topic | sepsis screening early warning scores antimicrobial resistance community hospital low-resource settings healthcare quality |
| url | https://www.mdpi.com/2079-6382/14/7/708 |
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