2109 Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study

Conclusion We linked 12870/24955 (51.6%) cases and identified 348/12870 (2.7%) with a positive reference standard. None of the strategies provided high sensitivity (>0.80) with acceptable positive predictive value (>0.15). The National Early Warning Score, version 2 (NEWS2) provided combinations of sensitivity and specificity that were similar or superior to all other early warning scores. The area under the receiver operating characteristic curve for NEWS2 applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% confidence interval [CI] 0.729 to 0.783). NEWS2 thresholds of >4, >6 and >8 applied to patients with a diagnostic impression of sepsis or infection respectively provided sensitivities and positive predictive values (95% CI) of 0.522 (0.469 to 0.574) and 0.216 (0.189 to 0.245), 0.447 (0.395 to 0.499) and 0.274 (0.239 to 0.313), and 0.314 (0.268 to 0.365) and 0.333 (CI 0.284 to 0.386). No strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2.
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: RCEM Moderated Source Type: research