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Comparative Study
. 2024 Nov:85:140-147.
doi: 10.1016/j.ajem.2024.08.037. Epub 2024 Sep 2.

Validation and comparison of triage-based screening strategies for sepsis

Kasra Rahmati  1 , Samuel M Brown  2 , Joseph R Bledsoe  3 , Paul Passey  4 , Peter P Taillac  5 , Scott T Youngquist  5 , Matthew M Samore  6 , Catherine L Hough  7 , Ithan D Peltan  8
Affiliations
Comparative Study

Validation and comparison of triage-based screening strategies for sepsis

Kasra Rahmati et al. Am J Emerg Med. 2024 Nov.

Abstract

Objective: This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage.

Methods: 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.

Results: 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 < 0.001 for all AUPRC and AUROC comparisons). The Predict Sepsis and Borelli scores exhibited sensitivity of 0.670 and 0.678 and specificity of 0.902 and 0.834, respectively, at their recommended cutoff values and outperformed Systemic Inflammatory Response Syndrome (SIRS) criteria (AUPRC 0.083, 95 % CI 0.070-0.102, p = 0.052 and p = 0.078, respectively; AUROC 0.775, 95 % CI 0.756-0.795, p < 0.001 for both scores).

Conclusions: The Predict Sepsis and Borelli scores exhibited improved performance including increased specificity and positive predictive values for sepsis identification at ED triage compared to CTAS and SIRS criteria.

Keywords: Emergency department (ED) triage; Prediction model validation; Screening; Sepsis.

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Conflict of interest statement

Declaration of competing interest Outside the present work, KR reports issued patent, IDP reports grant funding from Janssen Pharmaceuticals and payments to his institution for study enrollments from Regeneron and Bluejay Diagnostics, SMB reports royalties on a patent from ReddyPort. STY reports industry grant from CoLabs, and JRB reports payment from JAJ LLC medical consulting. Other authors report no conflicts of interest.

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