Table 3:
Diagnostic classification accuracy of screening strategies for prehospital identification of sepsis, based on published thresholds for patients with infection diagnosed in the emergency department
| Strategy* (score threshold) | Sensitivity (95% CI) | Specificity (95% CI) | PPV | NPV |
|---|---|---|---|---|
| Sepsis Alert | 0.07 (0.06–0.08) | 0.99 (0.99–0.99) | 0.68 | 0.79 |
| qSOFA (2) | 0.40 (0.38–0.42) | 0.94 (0.94–0.95) | 0.66 | 0.85 |
| PITSTOP | 0.02 (0.02–0.03) | 1.00 (1.00–1.00) | 0.65 | 0.79 |
| qSOFA + end-tidal carbon dioxide | 0.44 (0.42–0.46) | 0.92 (0.91–0.92) | 0.60 | 0.86 |
| PRESS (2)† | 0.11 (0.10–0.12) | 0.98 (0.97–0.98) | 0.56 | 0.80 |
| SEPSIS (5) | 0.26 (0.24–0.27) | 0.94 (0.94–0.95) | 0.55 | 0.82 |
| BAS (1) | 0.57( 0.55–0.59) | 0.79 (0.78–0.80) | 0.43 | 0.87 |
| Borrelli strategy (3) | 0.49 (0.47–0.51) | 0.86 (0.86–0.87) | 0.50 | 0.86 |
| MEWS (4) | 0.53 (0.51–0.55) | 0.77 (0.77–0.78) | 0.39 | 0.86 |
| PRESEP (4) | 0.49 (0.47–0.51) | 0.76 (0.75–0.77) | 0.36 | 0.84 |
| MBIS | 0.44 (0.42–0.46) | 0.77 (0.76–0.77) | 0.34 | 0.83 |
| PSP (2) | 0.42 (0.40–0.44) | 0.77 (0.76–0.78) | 0.33 | 0.83 |
| PreSAT (2) | 0.49 (0.47–0.50) | 0.71 (0.70–0.72) | 0.32 | 0.83 |
| PHANTASi | 0.20 (0.19–0.22) | 0.88 (0.87–0.89) | 0.32 | 0.80 |
| Robson score (2) | 0.75 (0.73–0.76) | 0.54 (0.53–0.55) | 0.31 | 0.89 |
| SIRS (2) | 0.45 (0.43–0.47) | 0.72 (0.71–0.73) | 0.31 | 0.83 |
| HEWS (2) | 0.85 (0.84–0.86) | 0.41 (0.40–0.42) | 0.28 | 0.91 |
| SIRS + end-tidal carbon dioxide | 0.74 (0.73–0.76) | 0.40 (0.39–0.41) | 0.25 | 0.85 |
| Suffoletto strategy | 0.70 (0.68–0.71) | 0.38 (0.37–0.39) | 0.23 | 0.82 |
Note: BAS = Blood Pressure Andningsfrekvens (“respiratory rate” in Swedish) Saturation, CI = confidence interval, HEWS = Hamilton Early Warning Score, MBIS = Mecklenburg Bacterial Infection Scale, MEWS = Modified Early Warning Score, NPV = negative predictive value, PHANTASi = Prehospital Antibiotics Against Sepsis, PITSTOP = Paramedic Initiated Treatment of Sepsis Targeting Out-of-Hospital Patients clinical trial, PPV = positive predictive value, PreSAT = Prehospital Sepsis Assessment Tool, PRESEP = Prehospital Early Sepsis Detection, PRESS = Prehospital Severe Sepsis, PSP = Prehospital Sepsis Project, qSOFA = Quick Sepsis-Related Organ Failure Assessment, SEPSIS = Screening to Enhance Prehospital Identification of Sepsis, SIRS = Systemic Inflammatory Response Syndrome.
Strategies are ordered by decreasing PPV. No studies reporting thresholds for the CIP (Critical Illness Prediction) score or NEWS (National Early Warning Score) score for identification of sepsis were identified; as such these strategies are not included in this table.
Authors included “nursing home transport” in calculation of their score, but this variable was not available in our data set.