Comparison of SIRS criteria and qSOFA score for identifying culture-positive sepsis in the emergency department: A prospective cross-sectional multicenter study

OBJECTIVE: To compare the daily practice of two Emergency Departments (ED) in the Netherlands, where SIRS criteria and qSOFA score are used differently as screening tool for culture-positive sepsis.

DESIGN: A prospective cross-sectional multicenter study.

SETTING: Two EDs at two European clinical teaching hospitals in the Netherlands.

PARTICIPANTS: 760 patients with suspected infection who meet SIRS criteria or have a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1st January 2018 until 1st March 2018 were included.

METHODS: SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups (1: SIRS+, qSOFA-, not treated according protocol (reference group); 2: SIRS+, qSOFA-, treated according protocol; 3: SIRS+, qSOFA+, treated according protocol; 4: SIRS-, qSOFA+, not treated according protocol; 5: SIRS-, qSOFA+, treated according protocol).

PRIMARY AND SECONDARY OUTCOME MEASURES: To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and ICU admission.

RESULTS: 98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% [95%CI 37.4%-45.2%] and 48.1% [95%CI 37.4%-58.9%], respectively. Hazard ratios (HR) were 0.79 [95%CI 0.40-1.56, p=0.500], 3.42 [95%CI 1.82-6.44, p<0.001], 18.94 [95%CI 2.48-144.89, p=0.005] and 4.97 [95%CI 1.44-17.16, p=0.011] for groups two to five, respectively.

CONCLUSION: qSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study showed that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED.