Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study

Abstract Background For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over...

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Autores principales:	Gideon H. P. Latten, Judith Polak, Audrey H. H. Merry, Jean W. M. Muris, Jan C. Ter Maaten, Tycho J. Olgers, Jochen W. L. Cals, Patricia M. Stassen
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Clinical rules Infection Emergency department Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/05517bb942b94e5fa9036e3d7c945197
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spelling	oai:doaj.org-article:05517bb942b94e5fa9036e3d7c9451972021-11-28T12:13:43ZFrequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study10.1186/s12245-021-00388-z1865-13721865-1380https://doaj.org/article/05517bb942b94e5fa9036e3d7c9451972021-11-01T00:00:00Zhttps://doi.org/10.1186/s12245-021-00388-zhttps://doaj.org/toc/1865-1372https://doaj.org/toc/1865-1380Abstract Background For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection. Methods Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations. Results We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7–17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3–65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations. Conclusion After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6–15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.Gideon H. P. LattenJudith PolakAudrey H. H. MerryJean W. M. MurisJan C. Ter MaatenTycho J. OlgersJochen W. L. CalsPatricia M. StassenBMCarticleClinical rulesInfectionEmergency departmentMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENInternational Journal of Emergency Medicine, Vol 14, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Clinical rules Infection Emergency department Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Clinical rules Infection Emergency department Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Gideon H. P. Latten Judith Polak Audrey H. H. Merry Jean W. M. Muris Jan C. Ter Maaten Tycho J. Olgers Jochen W. L. Cals Patricia M. Stassen Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
description	Abstract Background For emergency department (ED) patients with suspected infection, a vital sign-based clinical rule is often calculated shortly after the patient arrives. The clinical rule score (normal or abnormal) provides information about diagnosis and/or prognosis. Since vital signs vary over time, the clinical rule scores can change as well. In this prospective multicentre study, we investigate how often the scores of four frequently used clinical rules change during the ED stay of patients with suspected infection. Methods Adult (≥ 18 years) patients with suspected infection were prospectively included in three Dutch EDs between March 2016 and December 2019. Vital signs were measured in 30-min intervals and the quick Sequential Organ Failure Assessment (qSOFA) score, the Systemic Inflammatory Response Syndrome (SIRS) criteria, the Modified Early Warning Score and the National Early Warning Score (NEWS) score were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred (i.e. switched from normal to abnormal or vice versa). In addition, we investigated which vital signs caused most alterations. Results We included 1433 patients, of whom a clinical rule score changed once or more in 637 (44.5%) patients. In 6.7–17.5% (depending on the clinical rule) of patients with an initial negative clinical rule score, a positive score occurred later during ED stay. In over half (54.3–65.0%) of patients with an initial positive clinical rule score, the score became negative later on. The respiratory rate caused most (51.2%) alterations. Conclusion After ED arrival, alterations in qSOFA, SIRS, MEWS and/or NEWS score are present in almost half of patients with suspected infection. The most contributing vital sign to these alterations was the respiratory rate. One in 6–15 patients displayed an abnormal clinical rule score after a normal initial score. Clinicians should be aware of the frequency of these alterations in clinical rule scores, as clinical rules are widely used for diagnosis and/or prognosis and the optimal moment of assessing them is unknown.
format	article
author	Gideon H. P. Latten Judith Polak Audrey H. H. Merry Jean W. M. Muris Jan C. Ter Maaten Tycho J. Olgers Jochen W. L. Cals Patricia M. Stassen
author_facet	Gideon H. P. Latten Judith Polak Audrey H. H. Merry Jean W. M. Muris Jan C. Ter Maaten Tycho J. Olgers Jochen W. L. Cals Patricia M. Stassen
author_sort	Gideon H. P. Latten
title	Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
title_short	Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
title_full	Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
title_fullStr	Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
title_full_unstemmed	Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study
title_sort	frequency of alterations in qsofa, sirs, mews and news scores during the emergency department stay in infectious patients: a prospective study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/05517bb942b94e5fa9036e3d7c945197
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Frequency of alterations in qSOFA, SIRS, MEWS and NEWS scores during the emergency department stay in infectious patients: a prospective study

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