• Ari Moskowitz, Parth V Patel, Anne V Grossestreuer, Maureen Chase, Nathan I Shapiro, Katherine Berg, Michael N Cocchi, Mathias J Holmberg, Michael W Donnino, and Center for Resuscitation Science.
• 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 3Division of Critical Care, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA. 4Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
• Crit. Care Med. 2017 Nov 1; 45 (11): 1813-1819.

ObjectivesThe Sepsis III clinical criteria for the diagnosis of sepsis rely on scores derived to predict inhospital mortality. In this study, we introduce the novel outcome of "received critical care intervention" and investigate the related predictive performance of both the quick Sequential Organ Failure Assessment and the Systemic Inflammatory Response Syndrome criteria.DesignThis was a single-center, retrospective analysis of electronic health records.SettingTertiary care hospital in the United States.PatientsPatients with suspected infection who presented to the emergency department and were admitted to the hospital between January 2010 and December 2014.InterventionsSystemic Inflammatory Response Syndrome and quick Sequential Organ Failure Assessment scores were calculated, and their relationships to the receipt of critical care intervention and inhospital mortality were determined.Measurement And Main ResultsA total of 24,164 patients were included of whom 6,693 (27.7%) were admitted to an ICU within 48 hours; 4,453 (66.5%) patients admitted to the ICU received a critical care intervention. Among those with quick Sequential Organ Failure Assessment less than 2, 13.4% received a critical care intervention and 3.5% died compared with 48.2% and 13.4%, respectively, for quick Sequential Organ Failure Assessment greater than or equal to 2. The area under the receiver operating characteristic was similar whether quick Sequential Organ Failure Assessment was used to predict receipt of critical care intervention or inhospital mortality (0.74 [95% CI, 0.73-0.74] vs 0.71 [0.69-0.72]). The area under the receiver operating characteristic of Systemic Inflammatory Response Syndrome for critical care intervention (0.69) and mortality (0.66) was lower than that for quick Sequential Organ Failure Assessment (p < 0.001 for both outcomes). The sensitivity of quick Sequential Organ Failure Assessment for predicting critical care intervention was 38%.ConclusionsEmergency department patients with suspected infection and low quick Sequential Organ Failure Assessment scores frequently receive critical care interventions. The misclassification of these patients as "low risk," in combination with the low sensitivity of quick Sequential Organ Failure Assessment greater than or equal to 2, may diminish the clinical utility of the quick Sequential Organ Failure Assessment score for patients with suspected infection in the emergency department.

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