Abstract
Objective
We conducted this study to investigate whether ESI combined with qSOFA score (ESI + qSOFA) predicts hospital outcome better than ESI alone in the emergency department
(ED).
Methods
This was a retrospective study for patients aged over 15 years who visited an ED of a tertiary referral hospital from January 1st, 2015 to
December 31st, 2015. We calculated and compared predictive performances of ESI alone
and ESI + qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the
secondary outcome was composite outcome of in-hospital mortality and ICU admission.
We calculated in-hospital mortality rates by positive qSOFA in each subgroup divided
according to ESI levels (1, 2, 3, 4 + 5).
Results
43,748 patients were enrolled. The area under receiver-operating characteristics curves
were higher in ESI + qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777,
P < .001 for mortality; 0.778 vs. 0.774, P < .001 for composite outcome). In each subgroup divided by ESI levels, patients with
positive qSOFA had significantly higher in-hospital mortality rate compared to those
with negative qSOFA (20.4% vs. 14.7%, P = .117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P = .001 in ESI level 2 subgroup; 2.3% vs. 0.4%, P < .001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup).
Conclusion
The prognostic performance of ESI + qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within
each subgroup, patients with positive qSOFA had higher in-hospital mortality compared
to those with negative qSOFA.
Abbreviations:
ESI (Emergency Severity Index), qSOFA (quick sepsis-related organ failure assessment), qSOFA+ESI (whether ESI combined with qSOFA score), ICU (intensive care unit), ED (emergency department)Keywords
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Article Info
Publication History
Published online: February 04, 2018
Accepted:
January 26,
2018
Received in revised form:
January 24,
2018
Received:
December 13,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.