Comparison of qSOFA, SIRS, MEWS, NEWS/NEWS2 scales in their diagnostic and prognostic value for sepsis in ED patients with infection or suspected infection: A scoping review
Keywords:
sepsis, emergency, qSOFA, outcome, screening tools, SIRS, EWS, NEWS2, MEWSAbstract
Introduction: Sepsis is a significant cause of hospitalization, morbidity, and mortality and its early diagnosis is fundamental in its outcome. Sepsis-3 suggested the use of the qSOFA scale as a prognostic indicator in patients with sepsis, while the revised 2021 guidelines do not recommend qSOFA as a single screening tool compared to the other scales.
Purpose: The purpose of the present study was to compare qSOFA, SIRS, NEWS2, MEWS scales for their diagnostic and prognostic value in sepsis, among adult patients with infection or suspected infection in the ED.
Material and Method: A scoping review of published studies was conducted, involved ED adult patients with suspected infection, and mortality, ICU admission, diagnosis of sepsis and/or septic shock as studied outcomes. The PubMed, ScienceDirect, Scopus, EBSCO, and Google Scholar literature databases were searched since January 2016 to May 2023.
Results: Of the initial 2425 studies retrieved, 413 were screened for full text after removing duplicates and reading the title and abstract. High heterogeneity was observed in the design of the studies, concerned different scales thresholds, selection of different patient populations, and scale measurement time. Scales were compared directly with each other, in combination with biomarkers, with modified scales, or with tools of modern technology (e.g. machine learning). SIRS had the best sensitivity in mortality, followed by NEWS/NEWS2 while qSOFA was superior in mortality specificity followed by NEWS/NEWS2.
Conclusions: Despite the design heterogeneity of the studies, which may limit reliable conclusions, the use of NEWS/NEWS2 is more often recommended, since it is overall superior to other scales in its predictive and diagnostic value. The question of creating an ideal tool for the early patient-at-risk detection with suspected infection, remains unresolved.
