• Prangsai Wattanasit and Bodin Khwannimit.
• Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
• Am J Emerg Med. 2021 Aug 1; 46: 284-288.

IntroductionThe aims of this study were to evaluate the accuracy of early warnings scores including National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Mortality in Emergency Department Sepsis score (MEDS), Search Out Severity score (SOS) and compare them with quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) for detecting sepsis among infected patients at the emergency department (ED).MethodsA retrospective study was conducted at ED of a university hospital. Primary outcome was sepsis defined by sepsis-2 definition. Secondary outcomes were sepsis defined by sepsis-3 definition, hospital admission and in-hospital mortality.ResultsA total of 652 (83.9%) from 777 infected patients were classified as sepsis by sepsis-2. MEWS and SOS outperformed other scores in predicting sepsis with the area under receiver operating characteristic curve (AUC) (95%CI) 0.845 (0.805-0.885) and 0.839 (0.799-0.879), followed by NEWS 0.800 (0.753-0.846), MEDS 0.608 (0.551-0.665) and qSOFA 0.657 (0.609-0.706) (p < .001 for all). MEWS ≥3 had a sensitivity of 87.7%, specificity of 69.6%, positive and negative likelihood ratio of 2.88 and 0.18 for predicting sepsis by sepsis-2. Whereas, MEDS and NEWS presented the highest AUC for predicting sepsis according to sepsis-3 (AUC 0.738 and 0.722). NEWS ≥7 predicted sepsis by sepsis-3 with 53.3% sensitivity, 80.9% specificity, 2.75 positive likelihood ratio (LR+) and 0.59 negative likelihood ratio. qSOFA had the highest LR+ of 3.69 for predicting hospital mortality.ConclusionThe early warning scores, qSOFA and SIRS had limited decision making for predicting sepsis and adverse outcomes among infected patients.Copyright © 2020 Elsevier Inc. All rights reserved.

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