Table 3.
Test Characteristics of SPoT and qSOFA Vital-Signs Criteria for Validation Cohort.
| 1° Outcome: ED Vasopressors, Direct ICU Admission, and Treatment for Infection | 2° Outcome: ICU Admission Within 24 hrs and Treatment for Infection | |||||||
|---|---|---|---|---|---|---|---|---|
| Triage Sensitivity | Time to (+) Screen | Sensitivitya | Specificitya | Positive Predictive Valuea | Sensitivitya | Specificitya | Positive Predictive Valuea | |
| I. Diagnostic Test Characteristics of Vital-Signs Criterion Alone | ||||||||
| SPoT Vitals | 60% (45–74%)ǂ | 0.1 hours (0.0–0.8)* | 100% (93–100%)* | 89.1% (88.7–89.6%)¶ | 2.3% (1.7–3.0%)* | 73% (67–79%) | 89.6% (89.1–90.0%)¶ | 7.1% (6.1–8.3%)¶ |
| 30/50 | 50/50 | 17,488/19,620 | 50/2,182 | 155/212 | 17,431/19,458 | 155/2,182 | ||
| qSOFA Vitals | 28% (16–43%)ǂ | 0.7 hours (0.1–1.4)* | 86% (73–94%)* | 94.2% (93.8–94.5%)¶ | 3.6% (2.6–4.9%)* | 69% (62–75%) | 94.7% (94.4–95.0%)¶ | 12.4% (10.5–14.4%)¶ |
| 14/50 | 43/50 | 18,481/19,620 | 43/1,182 | 146/212 | 18,422/19,458 | 146/1,182 | ||
| II. Diagnostic Test Characteristics of Vital-Signs Criterion together with tCFI Criterion | ||||||||
| SPoT Vitals | 56% (41–70%)ǂ | 0.1 hours (0.0–0.8)* | 90% (78–97%) | 95.3% (95.0–95.6%)¶ | 4.7% (3.4–6.2%) | 63% (56–70%) | 95.7% (95.5–96.0%)¶ | 13.9% (11.8–16.3%)¶ |
| 28/50 | 45/50 | 18,704/19,620 | 45/961 | 134/212 | 18,631/19,458 | 134/961 | ||
| qSOFA Vitals | 28% (16–43%)ǂ | 0.7 hours (0.0–1.5)* | 80% (66–90%) | 97.0% (96.7–97.2%)¶ | 6.3% (4.5–8.5%) | 60% (53–67%) | 97.4% (97.2–97.6%)¶ | 20.0% (16.9–23.3%)¶ |
| 14/50 | 40/50 | 19,024/19,620 | 40/636 | 127/212 | 18,949/19,458 | 127/636 | ||
| III. Diagnostic Test Characteristics of Vital-Signs Criterion together with Singer’s “Suspected Infection” Criteria (Antibiotics and Blood Cultures Ordered)b | ||||||||
| SPoT Vitals | 50% (36–64%)ǂ | N/Ab | 80% (66–90%) | 98.5% (98.3–98.7%)¶ | 12.0% (8.7–16.0%) | 52% (45–59%) | 98.9% (98.7–99.0%)¶ | 33.3% (28.3–38.7%) |
| 25/50 | 40/50 | 19,327/19,620 | 40/333 | 111/212 | 19,236/19,458 | 111/333 | ||
| qSOFA Vitals | 24% (13–38%)ǂ | N/Ab | 70% (55–82%) | 98.9% (98.7–99.0%)¶ | 14.0% (9.9–18.9%) | 51% (44–57%) | 99.3% (99.1–99.4%)¶ | 42.8% (36.6–49.2%) |
| 12/50 | 35/50 | 19,405/19,620 | 35/250 | 107/212 | 19,315/19,458 | 107/250 | ||
Pairwise statistical comparisons of results for SPoT and qSOFA vital-signs criteria. For proportions, the percentages (and 95% confidence intervals) are shown above, as well as the raw counts for the relevant numerator and denominator in terms of ED subjects from the validation cohort. For times, the median (and interquartile range) are shown. For statistical tests-of-significance, we applied the McNemar exact conditional test for comparing sensitivities and specificities; the Fisher’s Exact Test for comparing positive predicative value; and the Wilcoxon signed-rank test for scalar results.
tCFI: triage criteria for infection (see Methods Section and Fig. 1 for details).
aBased on patients meeting vital-signs criteria at any time during ED course.
bAntibiotics & blood cultures are retrospective criteria for suspicion for infection as per Singer et al.7 which cannot be applied for prospective sepsis screening/decision-making.
*Significant difference, p < 0.05, in pairwise comparison between SPoT Vitals and qSOFA vitals, within each section (I, II and III) above.
ǂSignificant difference, p < 0.01, in pairwise comparison between SPoT Vitals and qSOFA vitals, within each section (I, II and III) above.
¶Significant difference, p < 0.001, in pairwise comparison between SPoT Vitals and qSOFA vitals, within each section (I, II and III) above.