Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals
Abstract Background This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying seps...
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-021-03921-3 |
| _version_ | 1819199911548157952 |
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| author | Nouf Abutheraa June Grant Alexander B. Mullen |
| author_facet | Nouf Abutheraa June Grant Alexander B. Mullen |
| author_sort | Nouf Abutheraa |
| collection | DOAJ |
| description | Abstract Background This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying sepsis by comparing them with positive culture. This study also sought to evaluate compliance with using the Sepsis Six Care Bundle (SSCB) operated in an individual health board. Methods A retrospective cohort study was conducted in 3 maternity hospitals of a single Scottish health board that admitted 2690 pregnancies in a 12 weeks period in 2016. Data for study was obtained from medical notes, handheld and electronic health records for women who were prescribed antibiotics with a confirmed or suspected diagnosis of sepsis. Data on clinical parameters was used to classify women according to mSIRS, qSOFA and MEWS as having sepsis or not and this was compared to results of positive culture to obtain sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under Receiver Operating Characteristic curve (AUROC) along with their 95% confidence intervals. Data was also obtained on SSCB compliance. Results A total of 89 women were diagnosed with sepsis, of which 14 had missing data, leaving 75 for final analysis. Sensitivity, specificity, PPV, NPV and AUROC of mSIRS and MEWS were almost similar with AUROC of both being around 50%. Only 33 (37.1%) had identifiable sepsis six sticker displayed on medical notes and only 2 (2.2%) had all elements of SSCB delivered within the recommended one-hour post-diagnosis period. Blood culture and full blood count with other lab tests had been performed for most women (97%) followed by intravenous antibiotics and fluids (93.9%). Conclusions mSIRS and MEWS were quite similar in detecting sepsis when compared to positive culture, with their ability to detect sepsis being close to chance. This underlines the need for creating a valid SSS with high sensitivity and specificity for clinical use in obstetric settings. Clinical use of SSCB was limited despite it being a health board policy, although there is considerable possibility of improvement following detailed audits and removal of barriers for implementing SSCB. |
| first_indexed | 2024-12-23T03:23:52Z |
| format | Article |
| id | doaj.art-4c0652bcdc924cafac42d5be04ad3a00 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-23T03:23:52Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-4c0652bcdc924cafac42d5be04ad3a002022-12-21T18:01:54ZengBMCBMC Pregnancy and Childbirth1471-23932021-07-012111710.1186/s12884-021-03921-3Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitalsNouf Abutheraa0June Grant1Alexander B. Mullen2Strathclyde Institute of Pharmacy and Biomedical Science in the University of StrathclydeObstetrics & Gynaecology, Women & Children’s Services at the NHS Greater Glasgow & ClydeStrathclyde Institute of Pharmacy and Biomedical Science in the University of StrathclydeAbstract Background This study aimed to assess the predictive power of three different Sepsis Scoring Systems (SSSs), namely maternity Systematic Inflammatory Response Syndrome (mSIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) and Modified Early Warning System (MEWS) in identifying sepsis by comparing them with positive culture. This study also sought to evaluate compliance with using the Sepsis Six Care Bundle (SSCB) operated in an individual health board. Methods A retrospective cohort study was conducted in 3 maternity hospitals of a single Scottish health board that admitted 2690 pregnancies in a 12 weeks period in 2016. Data for study was obtained from medical notes, handheld and electronic health records for women who were prescribed antibiotics with a confirmed or suspected diagnosis of sepsis. Data on clinical parameters was used to classify women according to mSIRS, qSOFA and MEWS as having sepsis or not and this was compared to results of positive culture to obtain sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under Receiver Operating Characteristic curve (AUROC) along with their 95% confidence intervals. Data was also obtained on SSCB compliance. Results A total of 89 women were diagnosed with sepsis, of which 14 had missing data, leaving 75 for final analysis. Sensitivity, specificity, PPV, NPV and AUROC of mSIRS and MEWS were almost similar with AUROC of both being around 50%. Only 33 (37.1%) had identifiable sepsis six sticker displayed on medical notes and only 2 (2.2%) had all elements of SSCB delivered within the recommended one-hour post-diagnosis period. Blood culture and full blood count with other lab tests had been performed for most women (97%) followed by intravenous antibiotics and fluids (93.9%). Conclusions mSIRS and MEWS were quite similar in detecting sepsis when compared to positive culture, with their ability to detect sepsis being close to chance. This underlines the need for creating a valid SSS with high sensitivity and specificity for clinical use in obstetric settings. Clinical use of SSCB was limited despite it being a health board policy, although there is considerable possibility of improvement following detailed audits and removal of barriers for implementing SSCB.https://doi.org/10.1186/s12884-021-03921-3SepsisSepsis scoring systemsSepsis diagnosisObstetricMaternitySystemic inflammatory response syndrome |
| spellingShingle | Nouf Abutheraa June Grant Alexander B. Mullen Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals BMC Pregnancy and Childbirth Sepsis Sepsis scoring systems Sepsis diagnosis Obstetric Maternity Systemic inflammatory response syndrome |
| title | Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals |
| title_full | Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals |
| title_fullStr | Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals |
| title_full_unstemmed | Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals |
| title_short | Sepsis scoring systems and use of the Sepsis six care bundle in maternity hospitals |
| title_sort | sepsis scoring systems and use of the sepsis six care bundle in maternity hospitals |
| topic | Sepsis Sepsis scoring systems Sepsis diagnosis Obstetric Maternity Systemic inflammatory response syndrome |
| url | https://doi.org/10.1186/s12884-021-03921-3 |
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