Rural Emergency Room Simulation Teaching and Education Resource
This is a brief 'update' on the 2015 Sepsis Guidelines. Or at least one interpretation!
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The following is from 'Journal Watch"
SIRS vs. qSOFA Score in the Emergency Department
Daniel M. Lindberg, MD reviewing Williams JM et al. Chest 2016 Nov 19.
The systemic inflammatory response syndrome is more sensitive, whereas the quick sequential organ function assessment score is more specific for predicting organ dysfunction and mortality.
Clinicians commonly underestimate infection severity in patients with sepsis, resulting in delayed treatment and worsened outcomes. The systemic inflammatory response syndrome (SIRS) can be an indicator of infection severity, but is not perfectly sensitive and is highly nonspecific. The quick sequential organ function assessment (qSOFA) score has been proposed as a better initial method to assess infection severity. These authors compared performance of the two scores in 8871 patients admitted from the emergency department with presumed infection.
Generally, SIRS was more sensitive for predicting infection severity, but qSOFA was more specific, with similar overall utility. For predicting organ dysfunction, the area under the receiver operating characteristics curve was similar for SIRS and qSOFA (0.72 and 0.73); a SIRS score ≥2 had sensitivity of 72% and specificity of 61% and a qSOFA score ≥2 had sensitivity of 30% and specificity of 96%. For predicting mortality, areas under the curve were 0.71 for SIRS and 0.78 for qSOFA; at a cutoff of ≥2, SIRS had sensitivity of 77% and specificity of only 54%, while qSOFA had sensitivity of 50% and specificity of 91%.
Neither of these scores is perfect, but both have their uses. Since many things can cause SIRS besides infection or sepsis, SIRS shouldn't make you think about infection if you wouldn't otherwise do so, and it shouldn't routinely trigger admission to the intensive care unit. Patients with infection and qSOFA score ≥2 are very sick with high mortality, but a low score should not reassure you. While these findings and others may disagree on the finer points of each score, the basics remain true: Respect abnormal vital signs, and patients who look sick should be treated aggressively