The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department—A Retrospective Assessment

Abstract

Objective

The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED).

Design

Retrospective data analysis study.

Setting

ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital.

Patients

Adult (age ≥ 18 years) patients presenting to the MWHC ED between June 1, 2017 and May 31, 2018 and admitted with a diagnosis of severe sepsis with or without shock.

Main Outcomes Measured

Availability of sepsis scoring criteria of eight different sepsis scoring methods at three time points—0 Hours (T0), 3 Hours (T1) and 6 Hours (T2) after arrival to the ED.

Results

A total of 50 charts were reviewed, which included 23 (46%) males and 27 (54%) females. Forty-eight patients (96%) were Black or African American. Glasgow Coma Scale was available for all 50 patients at T0. Vital signs, except for temperature, were readily available (>90%) at T0. The majority of laboratory values relevant for sepsis scoring criteria were available (>90%) at T1, with exception to bilirubin (66%) and creatinine (80%). NEWS, PRESEP and qSOFA had greater than 90% criteria availability at triage. SOFA and SIRS consistently had the least percent of available criteria at all time points in the ED.

Conclusion

The availability of patient data at different time points in a patient’s ED visit suggests that different scoring methods could be utilized to assess for sepsis as more patient information becomes available.

Keywords:

• sepsis
• scoring systems
• available criteria
• emergency department
• patient safety
• quality improvement

Author Contributions

KM conceived the study and its design. KM takes responsibility for the paper as a whole. SR, BF, CB undertook the creation of the database, data collection, statistical analysis, and data analysis. SR, BF, CB drafted the manuscript, and all authors contributed substantially to its revision. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Ms Robin Littlejohn reports grants from the National Library of Medicine, during the conduct of the study. Dr Ryan Arnold reports grants from NIH/NIGMS, during the conduct of the study. Dr Kristen Miller reports grants from the National Library of Medicine, during the conduct of the study. The authors report no other conflicts of interest in this work.