Sepsis recognition tools in acute ambulatory care: associations with process of care and clinical outcomes in a service evaluation of an Emergency Multidisciplinary Unit in Oxfordshire

Abstract

ObjectiveTo assess the performance of currently available sepsis recognition tools in patients referred to a community-based acute ambulatory care unit.DesignService evaluation of consecutive patients over a 4-month period.SettingCommunity-based acute ambulatory care unit.Data collection and outcome measuresObservations, blood results and outcome data were analysed from patients with a suspected infection. Clinical features at first assessment were used to populate sepsis recognition tools including: systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA) and National Institute for Health and Care Excellence (NICE) criteria. Scores were assessed against the clinical need for escalated care (use of intravenous antibiotics, fluids, ongoing ambulatory care or hospital treatment) and poor clinical outcome (all-cause mortality and readmission at 30 days after index assessment).ResultsOf 533 patients (median age 81 years), 316 had suspected infection with 120 patients requiring care escalated beyond simple community care. SIRS had the highest positive predictive value (50.9%, 95% CI 41.6% to 60.3%) and negative predictive value (68.9%, 95% CI 62.6% to 75.3%) for the need for escalated care. Both NEWS and SIRS were better at predicting the need for escalated care than qSOFA and NICE criteria in patients with suspected infection (all P<0.001). While new-onset confusion predicted the need for escalated care for infection in patients ≥85 years old (n=114), 23.7% of patients ≥85 years had new-onset confusion without evidence for infection.ConclusionsAcute ambulatory care clinicians should use caution in applying the new NICE endorsed criteria for determining the need for intravenous therapy and hospital-based location of care. NICE criteria have poorer performance when compared against NEWS and SIRS and new-onset confusion was prevalent in patients aged ≥85 years without infection.

Application of the Sepsis-3 Consensus Criteria in a Geriatric Acute Care Unit: A Prospective Study

“…To our knowledge, this is one of the few studies on the novel Sepsis-3 criteria specifically focused on geriatric multimorbid patients, and the first one performed in an acute-care geriatric ward. In fact, previous studies enrolling only subjects aged 70 or older were performed in emergency departments [36,37] or primary care [38]. The results of these studies are apparently in conflict with our findings, since they showed a good prognostic performance by qSOFA for short-term mortality in emergency departments [36,37] and a better prognostic performance by SIRS in primary care [38].…”

“…In fact, previous studies enrolling only subjects aged 70 or older were performed in emergency departments [36,37] or primary care [38]. The results of these studies are apparently in conflict with our findings, since they showed a good prognostic performance by qSOFA for short-term mortality in emergency departments [36,37] and a better prognostic performance by SIRS in primary care [38]. However, recent literature supports the concept that the predictive capacity of qSOFA and SIRS may differ, according to the characteristics of patients and healthcare settings [10,20], and this consideration also applies to older patients, who are admitted to non-ICU wards.…”

National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

“…These studies recruited a total of 107,008 participants, and the mortality rate in each study ranged from 2.5 to 32.8%. Five studies (20,24,27,31,32) were relatively small in sample size (<400), and 10 studies (19, 23, 26, 28-30, 33, 36, 37, 40) enrolled more than 1,000 patients. Ten studies (19,21,22,(27)(28)(29)(32)(33)(34)(35) included patients with suspected infection, and others focused on patients with suspected sepsis.…”

Nursing Care of Patient With Sepsis Due to Blast Injury

“…Kondisi trauma organ dan kerusakan permukaan tubuh yang luas menyebabkan pasien dengan cedera ledakan rentan mengalami sepsis. Sepsis merupakan kondisi disfungsi organ yang mengancam jiwa yang disebabkan oleh disregulasi respon tubuh terhadap infeksi (Camm et al, 2018;Finkelsztein et al, 2017).…”