Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study
Objectives We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana.Design Prospective cohort studies.Setting and participants From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome)...
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BMJ Publishing Group
2023-02-01
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| author | Christopher W Woods Daniel Ansong Emily Ko George Oduro Nehkonti Adams Andrew Letizia Charmagne Beckett Mark G Salvador William R Hulsey James V Lawler Kevin L Schully Paul W Blair Rittal Mehta Chris Kwaku Oppong Som Tin Ephraim L Tsalik Josh Chenoweth Michelle Rozo Deborah A Striegel Joost Brandsma Lauren McKean Rachael E Mahle Subramaniam Krishnan Michael Prouty Anne Fox Dennis Faix Chris Duplessis Michael G Gregory Te Vantha Alex Kwame Owusu-Ofori Danielle V Clark |
| author_facet | Christopher W Woods Daniel Ansong Emily Ko George Oduro Nehkonti Adams Andrew Letizia Charmagne Beckett Mark G Salvador William R Hulsey James V Lawler Kevin L Schully Paul W Blair Rittal Mehta Chris Kwaku Oppong Som Tin Ephraim L Tsalik Josh Chenoweth Michelle Rozo Deborah A Striegel Joost Brandsma Lauren McKean Rachael E Mahle Subramaniam Krishnan Michael Prouty Anne Fox Dennis Faix Chris Duplessis Michael G Gregory Te Vantha Alex Kwame Owusu-Ofori Danielle V Clark |
| author_sort | Christopher W Woods |
| collection | DOAJ |
| description | Objectives We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana.Design Prospective cohort studies.Setting and participants From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell’s C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test.Results The cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001).Conclusions Among the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use. |
| format | Article |
| id | doaj-art-985bdbc4adde4301b1d31e95179451ca |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-985bdbc4adde4301b1d31e95179451ca2025-08-20T03:01:22ZengBMJ Publishing GroupBMJ Open2044-60552023-02-0113210.1136/bmjopen-2022-067840Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation studyChristopher W Woods0Daniel Ansong1Emily Ko2George Oduro3Nehkonti Adams4Andrew Letizia5Charmagne Beckett6Mark G Salvador7William R Hulsey8James V Lawler9Kevin L Schully10Paul W Blair11Rittal Mehta12Chris Kwaku Oppong13Som Tin14Ephraim L Tsalik15Josh Chenoweth16Michelle Rozo17Deborah A Striegel18Joost Brandsma19Lauren McKean20Rachael E Mahle21Subramaniam Krishnan22Michael Prouty23Anne Fox24Dennis Faix25Chris Duplessis26Michael G Gregory27Te Vantha28Alex Kwame Owusu-Ofori29Danielle V Clark30Duke Clinical Research Institute, Durham, North Carolina, USAEmergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana2Cedars-Sinai Medical Center, Los Angeles, CA, USAKomfo Anokye Teaching Hospital, Kumasi, GhanaNaval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USANaval Medical Research Unit-3 Ghana Detachment, Accra, GhanaNaval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAHenry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAGlobal Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAEmergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, GhanaTakeo Provincial Referral Hospital, Takeo, CambodiaDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USADuke University School of Medicine, Durham, North Carolina, USAHenry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAUS Naval Medical Research Unit No 2, Phnom Penh, CambodiaNaval Medical Research Unit-3 Ghana Detachment, Accra, GhanaUS Naval Medical Research Unit No 2, Phnom Penh, CambodiaAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USAAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USATakeo Provincial Referral Hospital, Takeo, CambodiaLaboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, GhanaAustere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USAObjectives We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana.Design Prospective cohort studies.Setting and participants From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell’s C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test.Results The cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001).Conclusions Among the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use.https://bmjopen.bmj.com/content/13/2/e067840.full |
| spellingShingle | Christopher W Woods Daniel Ansong Emily Ko George Oduro Nehkonti Adams Andrew Letizia Charmagne Beckett Mark G Salvador William R Hulsey James V Lawler Kevin L Schully Paul W Blair Rittal Mehta Chris Kwaku Oppong Som Tin Ephraim L Tsalik Josh Chenoweth Michelle Rozo Deborah A Striegel Joost Brandsma Lauren McKean Rachael E Mahle Subramaniam Krishnan Michael Prouty Anne Fox Dennis Faix Chris Duplessis Michael G Gregory Te Vantha Alex Kwame Owusu-Ofori Danielle V Clark Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study BMJ Open |
| title | Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study |
| title_full | Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study |
| title_fullStr | Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study |
| title_full_unstemmed | Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study |
| title_short | Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study |
| title_sort | screening tools for predicting mortality of adults with suspected sepsis an international sepsis cohort validation study |
| url | https://bmjopen.bmj.com/content/13/2/e067840.full |
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