The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study
Abstract Background Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk strat...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13049-017-0436-3 |
| _version_ | 1819132561949982720 |
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| author | Bas de Groot Frank Stolwijk Mats Warmerdam Jacinta A. Lucke Gurpreet K. Singh Mo Abbas Simon P. Mooijaart Annemieke Ansems Laura Esteve Cuevas Douwe Rijpsma |
| author_facet | Bas de Groot Frank Stolwijk Mats Warmerdam Jacinta A. Lucke Gurpreet K. Singh Mo Abbas Simon P. Mooijaart Annemieke Ansems Laura Esteve Cuevas Douwe Rijpsma |
| author_sort | Bas de Groot |
| collection | DOAJ |
| description | Abstract Background Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk stratification of older ED sepsis patients (≥70 years) compared to a younger control group (<70 years). Methods This was an observational multi-centre study using an existing database in which ED patients who were hospitalized with a suspected infection were prospectively included. Patients were stratified by age < 70 and ≥70 years. We assessed the association with in-hospital mortality (primary outcome) and the area under the curve (AUC) with receiver operator characteristics of the Predisposition, Infection, Response, Organ dysfunction (PIRO), quick Sequential Organ Failure Assessment (qSOFA), Mortality in ED Sepsis (MEDS), and the Modified and National Early Warning (MEWS and NEWS) scores. Results In-hospital mortality was 9.5% ((95%-CI); 7.4–11.5) in the 783 included older patients, and 4.6% (3.6–5.7) in the 1497 included younger patients. In contrast to younger patients, disease severity scores in older patients associated poorly with mortality. The AUCs of all disease severity scores were poor and ranged from 0.56 to 0.64 in older patients, significantly lower than the good AUC range from 0.72 to 0.86 in younger patients. The MEDS had the best AUC (0.64 (0.57–0.71)) in older patients. In older and younger patients, the newly proposed qSOFA score (Sepsis 3.0) had a lower AUC than the PIRO score (sepsis 2.0). Conclusion The prognostic and discriminative performance of the five most commonly used disease severity scores was poor and less useful for risk stratification of older ED sepsis patients. |
| first_indexed | 2024-12-22T09:33:22Z |
| format | Article |
| id | doaj.art-f72c9e7fda25487dab36bbc730ef1ce8 |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-12-22T09:33:22Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-f72c9e7fda25487dab36bbc730ef1ce82022-12-21T18:30:54ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-09-0125111110.1186/s13049-017-0436-3The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre studyBas de Groot0Frank Stolwijk1Mats Warmerdam2Jacinta A. Lucke3Gurpreet K. Singh4Mo Abbas5Simon P. Mooijaart6Annemieke Ansems7Laura Esteve Cuevas8Douwe Rijpsma9Department of emergency medicine, Leiden University Medical CentreDepartment of emergency medicine, Leiden University Medical CentreDepartment of emergency medicine, Leiden University Medical CentreDepartment of emergency medicine, Leiden University Medical CentreDepartment of emergency medicine, Leiden University Medical CentreDepartment of emergency medicine, Leiden University Medical CentreDepartment of Gerontology and Geriatrics, Leiden University Medical CentreDepartment of emergency medicine, Albert Schweitzer ZiekenhuisDepartment of emergency medicine, Albert Schweitzer ZiekenhuisDepartment of emergency medicine, Rijnstate ZiekenhuisAbstract Background Sepsis recognition in older emergency department (ED) patients is difficult due to atypical symptom presentation. We therefore investigated whether the prognostic and discriminative performance of the five most commonly used disease severity scores were appropriate for risk stratification of older ED sepsis patients (≥70 years) compared to a younger control group (<70 years). Methods This was an observational multi-centre study using an existing database in which ED patients who were hospitalized with a suspected infection were prospectively included. Patients were stratified by age < 70 and ≥70 years. We assessed the association with in-hospital mortality (primary outcome) and the area under the curve (AUC) with receiver operator characteristics of the Predisposition, Infection, Response, Organ dysfunction (PIRO), quick Sequential Organ Failure Assessment (qSOFA), Mortality in ED Sepsis (MEDS), and the Modified and National Early Warning (MEWS and NEWS) scores. Results In-hospital mortality was 9.5% ((95%-CI); 7.4–11.5) in the 783 included older patients, and 4.6% (3.6–5.7) in the 1497 included younger patients. In contrast to younger patients, disease severity scores in older patients associated poorly with mortality. The AUCs of all disease severity scores were poor and ranged from 0.56 to 0.64 in older patients, significantly lower than the good AUC range from 0.72 to 0.86 in younger patients. The MEDS had the best AUC (0.64 (0.57–0.71)) in older patients. In older and younger patients, the newly proposed qSOFA score (Sepsis 3.0) had a lower AUC than the PIRO score (sepsis 2.0). Conclusion The prognostic and discriminative performance of the five most commonly used disease severity scores was poor and less useful for risk stratification of older ED sepsis patients.http://link.springer.com/article/10.1186/s13049-017-0436-3SepsisInfectious diseasesOlder patientsEmergency medical servicesRisk stratificationDisease severity scores |
| spellingShingle | Bas de Groot Frank Stolwijk Mats Warmerdam Jacinta A. Lucke Gurpreet K. Singh Mo Abbas Simon P. Mooijaart Annemieke Ansems Laura Esteve Cuevas Douwe Rijpsma The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Sepsis Infectious diseases Older patients Emergency medical services Risk stratification Disease severity scores |
| title | The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study |
| title_full | The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study |
| title_fullStr | The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study |
| title_full_unstemmed | The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study |
| title_short | The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study |
| title_sort | most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients an observational multi centre study |
| topic | Sepsis Infectious diseases Older patients Emergency medical services Risk stratification Disease severity scores |
| url | http://link.springer.com/article/10.1186/s13049-017-0436-3 |
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