Classifying sepsis patients in the emergency department using SIRS, qSOFA or MEWS

Objective: To determine the effect of qSOFA and SOFA compared with the MEWS and SIRS criteria on the classification of emergency department (ED) patients with an infection as having sepsis. Methods: A retrospective single-centre study was performed in a random sample of 600 medical patients who visited the ED of the Academic Medical Centre Amsterdam between 1 November 2015 and 1 November 2016. Data for the different sepsis scores, as well as general data and demographics were retrieved. Descriptive analytics and sensitivity/specificity analysis were used to evaluate the performance of the different sepsis tools. Results: Of 577 evaluable medical patients, 198 patients (34.3%) had a probable infection. The SIRS sepsis criteria, severe sepsis criteria, MEWS ≥ 5 and qSOFA criteria classified 141/198 (71.2%), 55/198 (27.8%), 58/198 (29.3%) and 17/198 patients (8.6%) respectively, as septic. The in-hospital mortality of patients classified as septic by the SIRS and qSOFA score was 6.4% and 29.4%. The qSOFA and SIRS score of ≥ 2 had a specificity of 93.7% (95% CI: 91.3-95.6) and 56.9% (52.7-61.1) in predicting in-hospital mortality. Conclusion: No major differences in gender, age, comorbidity and site of infection between patients with sepsis or severe sepsis classified by the SIRS, qSOFA criteria or MEWS of ≥ 5 were found. The qSOFA criteria classifies a smaller group of patients as septic compared with the SIRS or MEWS. Due to this strict selection, the qSOFA score seems unsuitable as a bedside tool in the work-up and treatment of sepsis at the ED.