1912. Implementation of Sepsis-3 Definition in the Emergency Department: Proposed of Case Detection in Real-Life Practice
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWeek-2018 poster.pdf (226.3 kB)
  • Background:

    Sepsis is a major public health concern. Revised definitions of sepsis in 2016 from the systemic inflammatory response syndrome (SIRS) criteria to the Sequential Organ Failure Assessment (SOFA) score made change in the sepsis case detection. One-hour bundle proposed by the Surviving Sepsis Campaign Bundle 2018 made the process more practically challenging because of its time-constraint.

    Methods:

    We retrospectively reviewed medical records of patients aged over 15 who visited the emergency department (ED) and got admitted to the internal medicine department from Jan-Feb 2018 in Somdech Phra Pinklao Hospital. Our study excluded pregnant women and patients who died within 48 hours after the admission. Data needed to complete SIRS, SOFA and quick SOFA (qSOFA) score was collected. Patients’ diagnosis, treatments and in-hospital mortality were also reviewed. Prevalence of sepsis according to each definition was calculated. Test performances were summarized separately using sensitivity, specificity, ROC and AUC.

    Results:

    We identified 217 cases, excluding 1 pregnancy and 5 patients who died within 48 hours. Prevalence of sepsis was 45.0% from SIRS ≥2, 30.3% from SOFA ≥2, and 11.8% from qSOFA ≥2. Because the high number of missing PaO2/FiO2 (96/188, 51.1%), we also calculated adjusted SOFA by excluding the factor. Sensitivity of SOFA ≥2 was 0.60 (0.49-0.70), specificity was 0.94 (0.88-0.98) and AUC was 0.77 (0.72-0.82), comparing to SIRS criteria. In-hospital mortality prediction using SIRS ≥2 had sensitivity of 0.78 (0.58-0.91), specificity of 0.38 (0.30-0.48) and AUC of 0.58 (0.49-0.67), while applying SOFA score ≥2 had sensitivity of 0.67 (0.46-0.83), specificity of 0.62 (0.52-0.70) and AUC of 0.64 (0.79-0.92). Two-step approach by screening patients who had SIRS ≥2, followed by detecting who had SOFA ≥2 had sensitivity of 0.81 (0.58-0.95), specificity of 0.46 (0.34-0.58) and AUC of 0.63 (0.53-0.74). No significant difference was found between applying adjusted or completed SOFA score. By using 2-step approach, about 55% decrease in number of patients needed to complete the SOFA score.

    Conclusion:

    Although SOFA score was a better diagnostic tool to detect sepsis than SIRS, applying the method for all patients in the ED is difficult to be practically implemented. We proposed 2-step approach by using SIRS ≥2 followed by SOFA score ≥2 for sepsis case detection.

    Pasri Maharom, MD, MPH1, Thammasin Inviya, MD, PhD2, Sorapop Pakdeewongse, M.D.1, Aungsumalin Sricharoon, BNS1, Kaimuk Thongyen, BNS1 and Chirapan Tantimongkolsuk, MD1, (1)Somdech Phra Pinklao Hospital, Naval Medical Department, Bangkok, Thailand, (2)Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand

    Disclosures:

    P. Maharom, None

    T. Inviya, None

    S. Pakdeewongse, None

    A. Sricharoon, None

    K. Thongyen, None

    C. Tantimongkolsuk, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.