The Use of Different Sepsis Risk Stratification Tools on the Wards and in Emergency Departments Uncovers Different Mortality Risks: Results of the Three Welsh National Multicenter Point-Prevalence Studies
582 auth.
Harry Unwin,
M. Kopczynska,
R. Pugh,
Laura Tan,
C. Subbe,
G. Ellis,
P. Morgan,
P. Havalda,
B. Sharif,
J. Burke,
T. Szakmany,
M. Hobrok,
M. Thomas,
A. Burden,
Nadia Youssef,
...
K. Carnegie,
Helena Colling-Sylvester,
N. Logier,
M. Alsaeed,
Hannah L Williams,
A. Ayob,
Nor Farzana,
Sweta S. Parida,
David Lawson,
Emily Evans,
L. Davis,
B. Atkins,
L. Davies,
L. Sanders-Crook,
S. Seal,
Alice Cains,
R. Pugh,
Katy Crisp,
Sarah Venning,
Elaine Sykes,
Stephanie Narine,
G. Parry,
Emily Angela Dillon,
Q. Z. Siah,
Ting-Yuan Yang,
T. Jones,
P. Thara,
Emma Wood,
Lara Wirt,
Georgina St Pier,
Richard K. Betts,
Kyriaki Mitsaki,
Mari Tachweed Pierce,
S. Davies,
Y. Hafouda,
Erin Ifan,
G. Lacey,
Francesca Mitchell,
J. Lynch,
Michael Mazur,
L. D’Souza,
B. Ponting,
Terrance Lau,
R. Kerrigan,
L. Morgan,
R. Vindla,
C. Zeicu,
B. James,
A. Ariff,
Wan Binti Wan Azzlan,
Charlotte Collins,
E. Wickens,
Alisa Norbee,
Aliya Zulkefli,
Thomas R. Haddock,
Megan Thomas,
M. Lee,
Miriam Cynan,
Nik Syakirah Nik Azis,
Imogen Hay,
Catherine Russell,
M. Vreugdenhil,
M. Abdimalik,
Joseph Davies,
P. Havalda,
Angharad Evans,
Kate Robertson,
G. Gitau,
M. Gruber,
T. Telford,
Anas Qarout,
N. Nandra,
Hannah Garrard,
J. Cutler,
Rhiannon Tammy Jones,
A. Prideaux,
Timothy Spence,
S. Hardie,
H. Seymour,
S. Willis,
Matthew Warlow,
Shanali Thanthilla,
Thomas Downs,
Nina Foley,
Chad McKeown,
A. Dandawate,
Holleh Shayan-Arani,
Ellie Taylor,
O. Kyriakides,
Rachel Price,
Ffion Haf Mackey,
E. Haines,
Samuel Chun,
N. Vignarajah,
T. Chamberlain,
Dongying Zhao,
N. N. Tantirige,
N. Dennehey,
Geo. T. Evans,
J. Watts,
C. Battle,
Ryan Jones,
S. Jones,
C. James,
James A. O’Hanlon,
I. Bridges,
Bethany Hughes,
Leo Polchar,
E. Bisson,
Charlotte Mykura,
L. Money,
J. McKenna,
Sarah E. Kinsman,
Demiana Hanna,
Emily L Baker,
H. Sprague,
Liam Sharma,
T. Pontin,
E. Shore,
T. Hughes,
S. Nightingale,
P. Baby,
M. Shield,
A. Cross,
Jenna Boss,
Olivia Ross,
G. Ashton,
Kimaya Pandit,
Daniel R Davies,
Cameron Garbutt,
Charlotte H. Johnston,
M. Cox,
C. Roberts,
A. Waller,
Laura Heekin,
Kathy Wang,
Rhianna Church,
Shrina Patel,
M. Broderick,
Hannah Whillis,
D. Hathaway,
Emel Yildirim,
C. Atkins,
E. Walters,
C. Durie,
Robert James Hamilton Sinnerton,
Benjamin Tanner,
Julimar Abreu,
K. Bashir,
V. Hamlyn,
Amelia Tee,
Z. Hinchcliffe,
Rita Otto,
G. Covell,
Megan Stone,
Victoria Maidman,
Katherine Godfray,
Rhidian Caradine,
H. Beetham,
A. Anomneze-Collins,
Jeanette Tan,
Y. Abdelrazik,
Azizah Khan,
N. Malik,
Aidan Clack,
L. Oliva,
T. Thomas,
A. Mounce,
A. Ramjeeawon,
Ndaba Mtunzi,
D. Soppitt,
J. Hale,
J. Wellington,
Robert Buchanan Ross,
Danielle Lis,
R. Parsonson,
Jude Joseph-Gubra,
Ajitha Arunthavarajah,
J. Nicholas,
Aaron Harris,
Henry Atkinson,
J. Webster,
T. Burnett,
Josephine Raffan Gowar,
Sam DeFriend,
J. Whitaker,
E. Beasant,
L. Macchiavello,
D. Usman,
A. Mahdi,
Tiffany Ye Tze Shan,
Nick Savill,
J. Gee,
L. Hodges,
A. Desai,
H. Rossiter,
Matthew Taylor,
K. Pinto,
Eleanor Hartley,
Oscar Emanuel,
Rhiannon Long,
M. Selby,
Elilis Wardle,
A. Urquhart,
Jack Barrington,
Matt Ashman,
E. Adcock,
A. Dickinson,
R. Jordache,
Rym Chafai El Alaoui,
Sophie Stovold,
Sam Vickery,
Nia Jones,
Alice O'Donnell,
Monty Cuthbert,
Osa Eghosa,
Muhammad Karim,
Lowri Williams,
L. Tucker,
T. Downs,
Rebecca Walford,
Annabelle Hook,
A. Mounce,
E. Eccles,
R. Edwards,
K. Ramesh,
Charlie C. Hall,
Maria Lazarou,
R. Jones,
Katy McGillian,
H. Bhachoo,
Zoe The,
Vithusha Inpahas,
R. Desai,
Y. Cheema,
Andrew Hughes,
Olivia Cranage,
F. Bee,
Khalid Osman,
Humza Khan,
Jennifer Pitt,
C. Pickwick,
J. Carter,
F. Andrew,
Naseera Seedat,
Roshni Patel,
Megan Walker,
Alicia Boam,
Jessica M. Randall,
B. Bowyer,
Josh Edwards,
Natasha Jones,
Emma Walker,
A. MacNaught,
S. Balachandran,
Abbie Shipley,
Jennifer Louise Kent,
Samuel Tilley,
B. Davies,
Emma J Withers,
Krishna Parmar,
L. Webber,
Angelica Sharma,
Amy Handley,
Alexandra Gordon,
L. Allen,
R. Paddock,
Harriet Penney,
Lopa Banerjee,
C. V. Vanderpump,
K. Harding,
John Burke,
O. Minik,
Nia Jarrett,
E. Rowe,
A. Anomneze-Collins,
H. Griffiths,
Sarah Pengelly,
Ffion Bennett,
A. Bilal,
A. El-badawey,
B. Ellis,
Luke Cook,
Harriet Elizabeth Valentine Maine,
Kiri Armstrong,
H. Beresford,
Timia Raven-Gregg,
Tom Liddell-Lowe,
C. Ong,
H. Reed,
Frederika Alice St John,
Weronika Julia Kozuch,
I. Ray,
Irukshi Anuprabha Silva,
Sin Ting Natalie Cheng,
Ummer Ali,
Noreen S. Syed,
L. Murphy,
T. Grother,
Harry Smith,
Rachel Watson,
O. Marei,
E. Kirby,
A. Gilfedder,
L. Maw,
S. O’Connor,
C. Maden,
H. Jones,
Hazel Preston,
Nur Amirah Binti Maliki,
M. Zimmerman,
Jessica Webber,
Llewelyn Jones,
Rebecca Phillips,
Lauren McCarthy,
Emily Hubbard,
L. Duffy,
A. Guerrier Sadler,
T. Szakmany,
O. Richards,
C. King,
C. Killick,
Yusuf Chema,
Kavita Shergill,
Y. Huen,
L. Lau,
Hannah Mustafa Ali,
L. Wilcock,
Molly Timlin,
Ayeesha Rela,
Daniel Smith,
S. Ireland,
Jennifer Evans,
Nayanatara Poobalan,
J. Pearce,
Thivya V Vadiveloo,
Zoe Black,
Daniel Elis Samuel,
Humaira Hussain,
J. Hawkins,
Z. Atiyah,
R. Creamer,
Maham Zafar,
Ahmad Almazeedi,
Hannah Brunnock,
Zain AL-abdeen Abbas Nasser,
M. Jeyanthi,
Poorya Moghbel,
K. Kwan,
Isobel Sutherland,
F. Davis,
Abigail Rogers,
Z. Tan,
Clare Chantrill,
Amal Robertson,
J. Foulkes,
Rahana Khanam,
Jomcy John,
Sarah Hannah Meehan,
H. Metezai,
Hannah Dawson,
Navrhinaa Vadivale,
Camilla Lee,
A. Dhadda,
S. Cleaver,
G. Logue,
Joy Inns,
I. Jones,
Robyn Howcroft,
Carys Gilbert,
M. Bradley,
Louise Pike,
R. Keeling,
Charldré Banks,
Eleanor Cochrane,
James McFadyen,
Matthew Mo,
E. Ireland,
Esme Brittain,
I. Laid,
Charlotte Green,
A. Mcforrester,
Xuong Michelle Ly,
Mariana Nalbanti,
R. Joseph,
Jack Tagg,
D. Purchase,
P. Myat,
A. Niina,
Tyler Joshua Jones,
Lowri Hughes Thomas,
Natalie Hoyle,
P. Benc,
Ellen Davies,
Meng-Chieh Wu,
D. Fellows,
Samuel Tilley,
Eloise Baxendale,
Karishma Khan,
A. Forrester,
Oliver Moore,
Hse Juinn Lim,
A. Owen,
F. Hussain,
Nima-banu Allybocus,
Maneha Sethi,
H. Waring,
Adeel Khan,
Claire Smith,
Nicholas Doyle,
Mohammad Yahya Amjad,
L. Galloway,
P. Morgan,
G. Ellis,
R. Lundin,
Haamed Al Hassan,
Bethan Markall,
Namratha Kaur,
E. Onyango,
H. Beard,
E. Field,
E. Nelson-Rowe,
Lizzie Adcock,
A. Stoddart,
Frederika A St John,
Mathoorika Sivananthan,
Rhys Jones,
Sung Yeon Kwak,
L. Farakish,
Holly Rhys-Ellis,
K. Moss,
Tallulah Ray,
Tessa David,
Talea Roberts,
Annie Quy,
Aniket Paranjape,
N. Poolworaluk,
M. Keast,
S. Yao,
D. Manning,
Isobel Irwin,
U. Asim,
E. Boggon,
I. Alkurd,
Genevieve Lawerece,
Jade Brown,
E. Murphy,
Evie Lambert,
J. Guilford,
B. Payne,
Mariam Almulaifi,
A. Poacher,
Sashiananthan Ganesananthan,
Berenice Cunningham-Walker,
C. Spooner,
Akanksha Kiran,
Nabeegh Nadeem,
V. Unadkat,
Esme Sparey,
David Li,
J. Smith,
India Corrin,
A. Kurani,
P. Mcnulty,
Ceri Brown,
Wojciech Groblewski,
S. Szőke,
A. Redman,
Esther McKeag,
Anastasia Donnir,
Gaautham Ravishangar,
E. Howard,
Charlotte Salmon,
Sara Tanatova,
J. Kew,
M. Clark,
E. Hannay,
Olesya Godsafe,
C. Houghton,
Francesca Lavric,
Rachel Mallinson,
C. Littler,
H. Reddy,
Andrew Campbell,
Benedict Soo,
Rachel Evans,
Georgina Donowho,
A. Cawthra,
Maddison Davies,
Matthew Lawrence Ashman,
J. Scriven,
James Vautrey,
S. Seet,
Imogen Britton,
A. Hodgson,
E. Twohey,
Joseph Robbins,
Vanessa Yeo Yung Ling,
Kimiya Asjadi,
Carven Chin Yee Shean,
Zoe McCarroll,
Oritseweyimi Amatotsero,
Hei Man Priscilla Chan,
John Ng Cho Hui,
A. Ashaye,
J. Acheampong,
Ayowade Adeleye,
S. Ahmed,
A. Chrysostomou,
Harry Unwin,
E. Ang,
N. McSwiney,
Yin Yin Lim,
Z. Lee,
S. Kulikouskaya,
Nur Zulkifili,
Sheryl Lim,
Lim Xin,
Adiya Urazbayeva,
Nur Haslina Ahmad Hanif,
Y. Ying,
A. Coleclough,
Eilis Higgins,
Naomi Spencer,
Tze Gee Ng,
Sam Booth,
Stephanie Wai Yee Ng,
C. Subbe,
Isabella Patterson,
W. L. Chia,
A. Mukit,
Hei Yi Vivian Pak,
F. Lock,
M. Nalmpanti,
S. Thomas,
T. Burgher,
Alfred Wei Zhen Yeo,
Siwan Powell Jones,
C. Miles,
Millicent Perry,
H. Burton,
K. Powell,
Luthfun Nessa,
Aalaa Fadlalla,
Rhian Morgan,
Elizabeth Hodges,
Amelia Heal,
C. Scott,
A. Tayler,
T. Chandy,
A. Taufik,
James Cochrane,
S. Willis,
S. Heng,
A. Cooper,
Henrik Graf von der Pahlen,
Isabella Talbot,
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J. Smith,
A. Sweeney,
Cerian Roberts,
Laura Bausor,
Chania,
D. Thomas,
E. W. Puw,
R. Lyons,
Judith E. Hall
Supplemental Digital Content is available in the text. OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk…
Supplemental Digital Content is available in the text. OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN: Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING: The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS: We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS: We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS: Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.
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