External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia

Naomi George; Marie-Carmelle Elie-Turenne; Raghu R Seethala; Tezcan Ozrazgat Baslanti; Shahab Bozorgmehri; Kemba Mark; David Meurer; Azra Bihorac; Imoigele P Aisiku; Peter C Hou; U.S. Critical Illness and Injury Trials Group–Lung Injury Prevention Study Investigators

doi:10.1016/j.jemermed.2019.08.043

External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia

J Emerg Med. 2019 Dec;57(6):755-764. doi: 10.1016/j.jemermed.2019.08.043. Epub 2019 Nov 15.

Affiliations

¹ Division of Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
² Department of Emergency Medicine, University of Florida, Gainesville, Florida.
³ Division of Nephrology, Department of Medicine, University of Florida, Gainesville, Florida.

PMID: 31735660
DOI: 10.1016/j.jemermed.2019.08.043

Abstract

Background: Pneumonia is the leading cause of sepsis. In 2016, the 3^rd International Consensus Conference for Sepsis released the Quick Sepsis-Related Organ Failure Assessment (qSOFA) to identify risk for poor outcomes in sepsis.

Objective: We sought to externally validate qSOFA in emergency department (ED) patients with pneumonia and compare the accuracy of qSOFA to systemic inflammatory response syndrome score (SIRS), Confusion, Respiratory Rate and Blood Pressure (CRB), Confusion, Respiratory Rate, Blood Pressure and Age (CRB-65), and DS CRB-65, which is based on the CRB-65 score and includes two additional items-presence of underlying comorbid disease and blood oxygen saturation.

Methods: A subgroup analysis of U.S. Critical Illness and Injury Trials Group (USCIITG-Lung Injury Prevention Study [LIPS]; ClinicalTrials.gov ID: NCT00889772) prospective cohort. The primary outcome was in-hospital mortality. Secondary outcomes were measures of intensive care unit (ICU) utilization. Sensitivity, specificity, and area under the curve (AUC) were reported.

Results: From March to August 2009, 5584 patients were enrolled; 713 met inclusion criteria. Median age was 61 years (interquartile range 49-75 years). SIRS criteria had the highest sensitivity for death (89%) and lowest specificity (25%), while CRB had the highest specificity (88%) and lowest sensitivity (31%), followed by qSOFA (80% and 53%, respectively). This trend was maintained for the secondary outcomes. There was no significant difference in the AUC for death using qSOFA (AUC 0.75; 95% confidence interval [CI] 0.66-0.84), SIRS (AUC 0.70; 95% CI 0.61-0.78), CRB (AUC 0.71; 95% CI 0.62-0.80), CRB-65 (AUC 0.71; 95% CI 0.63-0.80), and DS CRB-65 (AUC 0.73; 95% CI 0.64-0.82).

Conclusions: In this multicenter observational study of ED patients hospitalized with pneumonia, we found no significant differences between qSOFA and SIRS for predicting in-hospital death. In addition, several popular pneumonia-specific severity scores performed nearly identically to qSOFA score in predicting death and ICU utilization. Validation is needed in a larger sample.

Keywords: CRB; CRB-65; emergency department; mortality; pneumonia; qSOFA; sepsis.

Publication types

Multicenter Study
Observational Study

MeSH terms

Adult
Aged
Area Under Curve
Cohort Studies
Emergency Service, Hospital / organization & administration
Emergency Service, Hospital / standards*
Emergency Service, Hospital / statistics & numerical data
Female
Humans
Male
Middle Aged
Organ Dysfunction Scores*
Pneumonia / classification*
Pneumonia / physiopathology
Prospective Studies
ROC Curve
Retrospective Studies
Severity of Illness Index

Associated data

ClinicalTrials.gov/NCT00889772