Assessing the Efficacy of Early Warning Scores in Predicting Sepsis Outcomes in Emergency Departments
Early Warning Systems for Sepsis Outcomes
DOI:
https://doi.org/10.69750/dmls.02.01.088Keywords:
Sepsis, Early Warning Scores, National Early Warning Score (NEWS), Emergency Department, Mortality, ICU Admission, Resource-Limited SettingsAbstract
Background: Early recognition of sepsis is a critical challenge in emergency medicine, particularly in resource-constrained settings, where timely intervention is essential to improve patient outcomes.
Objective: This study aimed to compare the effectiveness of different Early Warning Scores (EWS), including the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick Sequential Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS), in predicting outcomes such as mortality, ICU admission, and septic shock in the emergency departments of Pakistan.
Methods: A retrospective study was conducted at the Emergency Department of Khyber Teaching Hospital, Peshawar, from January to December 2024. Patients diagnosed with sepsis based on Sepsis-3 criteria were included. The predictive performance of each EWS was assessed using AUROC, logistic regression, and calibration plots.
Results: NEWS demonstrated superior predictive accuracy for in-hospital mortality (AUROC: 0.873) and ICU admission (AUROC: 0.890) compared to MEWS, qSOFA, and SIRS. It showed robust sensitivity (88%) and specificity (75%) and was identified as an independent predictor of mortality and ICU admission through multivariate analysis.
Conclusion: In resource-limited settings, NEWS proved to be the most effective tool for early risk stratification in sepsis patients. Its adoption could significantly enhance sepsis management and improve outcomes in emergency departments with constrained resources.
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Wattanasit P, Khwannimit B. Comparison the accuracy of early warning scores with qSOFA and SIRS for predicting sepsis in the emergency department. Am J Emerg Med. 2021;46:284-8.doi: 10.1016/j.ajem.2020.07.077
Asgarzadeh S, Ebadi A, Shahrbabaki AS, Safari S, Aghili SH, Farhang Ranjbar M, et al. National Early Warning Score in Predicting Adverse Outcomes for Patients Admitted to Emergency Department; a Prognostic Accuracy Study. Arch Acad Emerg Med. 2024;12(1):e1.doi: 10.22037/aaem.v12i1.2155
Chua WL, Rusli KDB, Aitken LM. Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: A systematic review and meta-analysis. Journal of Clinical Nursing. 2024;33(6):2005-18.doi:10.1111/jocn.17061 DOI: https://doi.org/10.1111/jocn.17061
Liengswangwong W, Siriwannabhorn R, Leela-Amornsin S, Yuksen C, Sanguanwit P, Duangsri C, et al. Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments. BMC Emergency Medicine. 2024;24(1):161.doi: 10.1186/s12873-024-01078-8 DOI: https://doi.org/10.1186/s12873-024-01078-8
Wattanasit P, Khwannimit B. Comparison the accuracy of early warning scores with qSOFA and SIRS for predicting sepsis in the emergency department. The American Journal of Emergency Medicine. 2021;46:284-8.doi: 10.1016/j.ajem.2020.07.077 DOI: https://doi.org/10.1016/j.ajem.2020.07.077
Hsieh M-S, Chiu K-C, Chattopadhyay A, Lu T-P, Liao S-H, Chang C-M, et al. Utilizing the National Early Warning Score 2 (NEWS2) to confirm the impact of emergency department management in sepsis patients: a cohort study from taiwan 1998–2020. International Journal of Emergency Medicine. 2024;17(1):42.doi: 10.1186/s12245-024-00614-4 DOI: https://doi.org/10.1186/s12245-024-00614-4
Nannan Panday RS, Minderhoud TC, Alam N, Nanayakkara PWB. Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review. European Journal of Internal Medicine. 2017;45:20-31.doi: 10.1016/j.ejim.2017.09.027 DOI: https://doi.org/10.1016/j.ejim.2017.09.027
Liu VX, Lu Y, Carey KA, Gilbert ER, Afshar M, Akel M, et al. Comparison of Early Warning Scoring Systems for Hospitalized Patients With and Without Infection at Risk for In-Hospital Mortality and Transfer to the Intensive Care Unit. JAMA Network Open. 2020;3(5):e205191-e.doi: 10.1001/jamanetworkopen.2020.5191 DOI: https://doi.org/10.1001/jamanetworkopen.2020.5191
Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I, et al. Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. Journal of Personalized Medicine [Internet]. 2021; 11(3).doi: 10.3390/jpm11030170 DOI: https://doi.org/10.3390/jpm11030170
Hamilton F, Arnold D, Baird A, Albur M, Whiting P. Early Warning Scores do not accurately predict mortality in sepsis: A meta-analysis and systematic review of the literature. Journal of Infection. 2018;76(3):241-8.doi: 10.1016/j.jinf.2018.01.002 DOI: https://doi.org/10.1016/j.jinf.2018.01.002
Pullyblank A, Tavaré A, Little H, Redfern E, le Roux H, Inada-Kim M, et al. Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project. British Journal of General Practice. 2020;70(695):e381.doi: 10.3399/bjgp20X709349 DOI: https://doi.org/10.3399/bjgp20X709349
Zhang K, Zhang X, Ding W, Xuan N, Tian B, Huang T, et al. National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis. Frontiers in Medicine. 2021;8.doi: 10.3389/fmed.2021.704358 DOI: https://doi.org/10.3389/fmed.2021.704358
Guan G, Lee CMY, Begg S, Crombie A, Mnatzaganian G. The use of early warning system scores in prehospital and emergency department settings to predict clinical deterioration: A systematic review and meta-analysis. PLOS ONE. 2022;17(3):e0265559.doi: 10.1371/journal.pone.0265559 DOI: https://doi.org/10.1371/journal.pone.0265559
Goodacre S, Sutton L, Thomas B, Hawksworth O, Iftikhar K, Croft S, et al. Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study. Emergency Medicine Journal. 2023;40(11):768.doi: 10.1136/emermed-2023-213315 DOI: https://doi.org/10.1136/emermed-2023-213315
Yu SC, Shivakumar N, Betthauser K, Gupta A, Lai AM, Kollef MH, et al. Comparison of early warning scores for sepsis early identification and prediction in the general ward setting. JAMIA Open. 2021;4(3):ooab062.doi: 10.1093/jamiaopen/ooab062 DOI: https://doi.org/10.1093/jamiaopen/ooab062
Aygun U, Yagin FH, Yagin B, Yasar S, Colak C, Ozkan AS, et al. Assessment of Sepsis Risk at Admission to the Emergency Department: Clinical Interpretable Prediction Model. Diagnostics [Internet]. 2024; 14(5).doi: 10.3390/diagnostics14050457 DOI: https://doi.org/10.3390/diagnostics14050457
McLymont N, Glover GW. Scoring systems for the characterization of sepsis and associated outcomes. Annals of Translational Medicine. 2016;4(24):527. DOI: https://doi.org/10.21037/atm.2016.12.53
Kim SH, Choi HS, Jin ES, Choi H, Lee H, Lee S-H, et al. Predicting severe outcomes using national early warning score (NEWS) in patients identified by a rapid response system: a retrospective cohort study. Scientific Reports. 2021;11(1):18021.doi: 10.1038/s41598-021-97121-w DOI: https://doi.org/10.1038/s41598-021-97121-w
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