Validation and comparison of triage-based screening strategies for sepsis

This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage. This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to...

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Bibliographic Details
Published in:The American journal of emergency medicine 2024-11, Vol.85, p.140-147
Main Authors: Rahmati, Kasra, Brown, Samuel M., Bledsoe, Joseph R., Passey, Paul, Taillac, Peter P., Youngquist, Scott T., Samore, Matthew M., Hough, Catherine L., Peltan, Ithan D.
Format: Article
Language:English
Subjects:
Acuity
Adult
Aged
Case-Control Studies
Data analysis
Documentation
Electronic health records
Emergency department (ED) triage
Emergency medical care
Emergency Service, Hospital
Female
Hospitals
Humans
Infections
Inflammation
Male
Mass Screening - methods
Mass Screening - standards
Medical records
Middle Aged
Missing data
Patients
Prediction model validation
Risk assessment
Risk Assessment - methods
ROC Curve
Screening
Sensitivity and Specificity
Sepsis
Sepsis - diagnosis
Systemic inflammatory response syndrome
Triage - methods
Utah
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Summary:This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage. This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to use at ED triage based on their area under the precision-recall curve (AUPRC, which balances positive predictive value and sensitivity) and area under the receiver operator characteristic curve (AUROC, which balances sensitivity and specificity). Score performance for predicting whether patients met Sepsis-3 criteria in the ED was compared to patients' assigned ED triage score (Canadian Triage Acuity Score [CTAS]) with adjustment for multiple comparisons. Among 2000 case/control patients, 981 met Sepsis-3 criteria on final adjudication. The best performing sepsis risk scores were the Predict Sepsis version #3 (AUPRC 0.183, 95 % CI 0.148–0.256; AUROC 0.859, 95 % CI 0.843–0.875) and Borelli scores (AUPRC 0.127, 95 % CI 0.107–0.160, AUROC 0.845, 95 % CI 0.829–0.862), which significantly outperformed CTAS (AUPRC 0.038, 95 % CI 0.035–0.042, AUROC 0.650, 95 % CI 0.628–0.671, p 
ISSN:0735-6757
1532-8171
1532-8171
DOI:10.1016/j.ajem.2024.08.037