Sepsis Series, part V
The CEP Work, Continued
In addition to the development of a Sepsis Flow chart (available from last week’s post), the CEP sepsis project has been looking at the sensitivities and specificities of sepsis screening tools. Using data from patients either admitted with a diagnosis of sepsis over a 13-month period, theses values were calculated.
National Early Warning Score takes into account heart rate, respiratory rate, oxygen saturation, need for supplemental oxygen, temperature, systolic blood pressure and change in mental status
Ranges in score from 0-18 with higher scores indicating the need for assessment for a higher level of care
In our study, a NEWS ≥6 had a sensitivity of 87% and a specificity of 50% for mortality
Elevated lactates have been independently associated with higher mortality, particularly at levels greater than 4 mmol/L, which corresponds to “septic shock” by CMS definitions
We found a lactate of ≥2 to be 93% sensitivity and 45% specific, while a higher cut off of 4 was more specific at 81%
Prior studies have shown that, independent of other variables, the more Acute Organ Dysfunctions a patient has, the higher the rate of death
In our cohort, having ≥4 AODs carried a 99% specificity for mortality but was 17% sensitive
qSOFA, the new kid on the block, only takes into account mental status, respiratory rate and blood pressure (all three of which are components of the NEWS)
We found a 77% sensitivity and a 69% specificity with a qSOFA of ≥2
Overall, we found that there is no single sepsis screening tool that can be used in isolation and adequately capture the patients at risk for mortality. However, each of these tools is of value to the emergency physician an when the screening tools were taken together, there was a combined sensitivity of 98%, indicating that each score may help identify different subsets of septic patients at higher risk for mortality.