• Emerg Med J · Nov 2023

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

    • Steve Goodacre, Laura Sutton, Ben Thomas, Olivia Hawksworth, Khurram Iftikhar, Susan Croft, Gordon Fuller, Simon Waterhouse, Daniel Hind, Mike Bradburn, Michael Anthony Smyth, Gavin D Perkins, Mark Millins, Andy Rosser, Jon M Dickson, and Matthew Joseph Wilson.
    • Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK s.goodacre@sheffield.ac.uk.
    • Emerg Med J. 2023 Nov 1; 40 (11): 768776768-776.

    BackgroundAmbulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment.MethodsWe undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019. We used routine ambulance service data to calculate 21 early warning scores and categorise paramedic diagnostic impressions as sepsis, infection, non-specific presentation or other presentation. We linked cases to hospital records and identified those meeting the sepsis-3 definition who received urgent hospital treatment for sepsis (reference standard). Analysis determined the accuracy of strategies that combined early warning scores at varying thresholds for positivity with paramedic diagnostic impression.ResultsWe linked 12 870/24 955 (51.6%) cases and identified 348/12 870 (2.7%) with a positive reference standard. None of the strategies provided sensitivity greater than 0.80 with positive predictive value greater than 0.15. The area under the receiver operating characteristic curve for the National Early Warning Score, version 2 (NEWS2) applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% CI 0.729, 0.783). No other early warning score provided clearly superior accuracy to NEWS2. Paramedic impression of sepsis or infection had sensitivity of 0.572 (0.519, 0.623) and positive predictive value of 0.156 (0.137, 0.176). 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 of 0.522 (0.469, 0.574) and 0.216 (0.189, 0.245), 0.447 (0.395, 0.499) and 0.274 (0.239, 0.313), and 0.314 (0.268, 0.365) and 0.333 (0.284, 0.386).ConclusionNo 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.Trial Registration Numberresearchregistry5268, https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/5de7bbd97ca5b50015041c33/.© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.

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