OBJECTIVES: The Sepsis-3 task force recommended the quick Sequential (Sepsis-Related) Organ Failure Assessment score for identifying patients with suspected infection who are at greater risk of poor outcomes, but many hospitals already use the National Early Warning Score to identify high-risk patients, irrespective of diagnosis. We sought to compare the performance of quick Sequential (Sepsis-Related) Organ Failure Assessment and National Early Warning Score in hospitalized, non-ICU patients with and without an infection.
DESIGN: Retrospective cohort study.
SETTING: Large U.K. General Hospital.
PATIENTS: Adults hospitalized between January 1, 2010, and February 1, 2016.
MEASUREMENTS AND MAIN RESULTS: We applied the quick Sequential (Sepsis-Related) Organ Failure Assessment score and National Early Warning Score to 5,435,344 vital signs sets (241,996 hospital admissions). Patients were categorized as having no infection, primary infection, or secondary infection using International Classification of Diseases, 10th Edition codes. National Early Warning Score was significantly better at discriminating in-hospital mortality, irrespective of infection status (no infection, National Early Warning Score 0.831 [0.825-0.838] vs quick Sequential [Sepsis-Related] Organ Failure Assessment 0.688 [0.680-0.695]; primary infection, National Early Warning Score 0.805 [0.799-0.812] vs quick Sequential [Sepsis-Related] Organ Failure Assessment 0.677 [0.670-0.685]). Similarly, National Early Warning Score performed significantly better in all patient groups (all admissions, emergency medicine admissions, and emergency surgery admissions) for all outcomes studied. Overall, quick Sequential (Sepsis-Related) Organ Failure Assessment performed no better, and often worse, in admissions with infection than without.
CONCLUSIONS: The National Early Warning Score outperforms the quick Sequential (Sepsis-Related) Organ Failure Assessment score, irrespective of infection status. These findings suggest that quick Sequential (Sepsis-Related) Organ Failure Assessment should be reevaluated as the system of choice for identifying non-ICU patients with suspected infection who are at greater risk of poor outcome.
qSOFA is very popular with clinicians and is in wide use. It is so popular that some are misapplying it to the diagnosis of sepsis when it’s intended use is really for prognostic value. This is only a single center study and is not an RCT that demonstrates mortality reduction from use of NEWS; however, even retrospective evidence that the NEWS score might be as good or better as qSOFA would be important news (pun intended). The qNEWS score is also notable because, while not as good as the NEWS score, it does not require knowing the oxygen saturation as NEWS does, making it easier to apply. Regarding qNEWS vs qSOFA: qSOFA requires computation of the glascow coma score that, although not difficult, is more complex than just determining the mental status as required in qNEWS.
We do not use NEWS here in our ICU, so I wonder how common this is here vs England where the study took place.