• Maja Kopczynska, Ben Sharif, Sian Cleaver, Naomi Spencer, Amit Kurani, Camilla Lee, Jessica Davis, Carys Durie, Jude Joseph-Gubral, Angelica Sharma, Lucy Allen, Billie Atkins, Alex Gordon, Llewelyn Jones, Amy Noble, Matthew Bradley, Henry Atkinson, Joy Inns, Harriet Penney, Carys Gilbert, Rebecca Walford, Louise Pike, Ross Edwards, Robyn Howcroft, Hazel Preston, Jennifer Gee, Nicholas Doyle, Charlotte Maden, Claire Smith, Nik Syakirah Nik Azis, Navrhinaa Vadivale, Ceri Battle, Ronan Lyons, Paul Morgan, Richard Pugh, Tamas Szakmany, and Welsh Digital Data Collection Platform Collaborators.
• Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Heath Park Campus, Cardiff.
• Medicine (Baltimore). 2018 Dec 1; 97 (49): e13238e13238.

AbstractControversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of "Red Flag sepsis criteria" has not been tested formally.The aim of the study was to investigate the ability of Red Flag sepsis criteria to identify the patients at high risk of sepsis-related death in comparison to SOFA based sepsis criteria. We also investigated the comparison of Red Flag sepsis to quick SOFA (qSOFA), SIRS, and national early warning score (NEWS) scores and factors influencing patient mortality.Patients were recruited into a 24-hour point-prevalence study on the general wards and emergency departments across all Welsh acute hospitals. Inclusion criteria were: clinical suspicion of infection and NEWS 3 or above in-line with established escalation criteria in Wales. Data on Red Flag sepsis and SOFA criteria was collected together with qSOFA and SIRS scores and 90-day mortality.459 patients were recruited over a 24-hour period. 246 were positive for Red Flag sepsis, mortality 33.7% (83/246); 241 for SOFA based sepsis criteria, mortality 39.4% (95/241); 54 for qSOFA, mortality 57.4% (31/54), and 268 for SIRS, mortality 33.6% (90/268). 55 patients were not picked up by any criteria. We found that older age was associated with death with OR (95% CI) of 1.03 (1.02-1.04); higher frailty score 1.24 (1.11-1.40); DNA-CPR order 1.74 (1.14-2.65); ceiling of care 1.55 (1.02-2.33); and SOFA score of 2 and above 1.69 (1.16-2.47).The different clinical tools captured different subsets of the at-risk population, with similar sensitivity. SOFA score 2 or above was independently associated with increased risk of death at 90 days. The sequalae of infection-related organ dysfunction cannot be reliably captured based on routine clinical and physiological parameters alone.

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