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Performance of NEWS2, RETTS, clinical judgment and the Predict Sepsis screening tools with respect to identification of sepsis among ambulance patients with suspected infection: a prospective cohort study
Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden; Fisksätra Vårdcentral (Primary Health Care Center), Saltsjöbaden, Sweden.
Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.ORCID iD: 0000-0003-3290-4111
2021 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 29, no 1, article id 144Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is little evidence of which sepsis screening tool to use in the ambulance setting. The primary aim of the current study was to compare the performance of NEWS2 (National Early Warning score 2) and RETTS (Rapid Emergency Triage and Treatment System) with respect to identification of sepsis among ambulance patients with clinically suspected infection. The secondary aim was to compare the performance of the novel Predict Sepsis screening tools with that of NEWS2, RETTS and clinical judgment.

METHODS: Prospective cohort study of 323 adult ambulance patients with clinically suspected infection, transported to hospitals in Stockholm, during 2017/2018. The sensitivity, specificity, and AUC (Area Under the receiver operating Curve) were calculated and compared by using McNemar´s test and DeLong's test.

RESULTS: The prevalence of sepsis in the current study population was 44.6% (144 of 323 patients). No significant difference in AUC was demonstrated between NEWS2 ≥ 5 and RETTS ≥ orange. NEWS2 ≥ 7 demonstrated a significantly greater AUC than RETTS red. The Predict Sepsis screening tools ≥ 2 demonstrated the highest sensitivity (range 0.87-0.91), along with RETTS ≥ orange (0.83), but the lowest specificity (range 0.39-0.49). The AUC of NEWS2 (0.73) and the Predict Sepsis screening tools (range 0.75-0.77) was similar.

CONCLUSIONS: The results indicate that NEWS2 could be the better alternative for sepsis identification in the ambulance, as compared to RETTS. The Predict Sepsis screening tools demonstrated a high sensitivity and AUCs similar to that of NEWS2. However, these results need to be interpreted with caution as the Predict Sepsis screening tools require external validation.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT03249597. Registered 15 August 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03249597 .

Place, publisher, year, edition, pages
BioMed Central, 2021. Vol. 29, no 1, article id 144
Keywords [en]
Emergency care, Emergency medical services, Prehospital, Screening, Sepsis
National Category
Nursing Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-94786DOI: 10.1186/s13049-021-00958-3ISI: 000702372300001PubMedID: 34593001Scopus ID: 2-s2.0-85116007524OAI: oai:DiVA.org:oru-94786DiVA, id: diva2:1600048
Note

Funding agencies:

Örebro University

Laerdal, Falck Foundation

Emergency Department of Södersjukhuset, Stockholm

Available from: 2021-10-04 Created: 2021-10-04 Last updated: 2024-01-17Bibliographically approved

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Wallgren, Ulrika M.Kurland, Lisa

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