COMPARING THE qSOFA WITH CLINICIAN GESTALT TO PREDICT IN HOSPITAL MORTALITY IN ADULTS WITH SUSPECTED INFECTION PRESENTING TO THE EMERGENCY DEPARTMENT AT THE COLONIAL WAR MEMORIAL HOSPITAL (CWMH)

BACKGROUND: Following the new sepsis definition in 2016 by the European Society of Intensive Care Medicine (ESICM) – Society of the Critical Care Medicine (SCCM) taskforce, recommendations for prospective validation of the qSOFA to predict in hospital mortality was made with more studies to be conducted in Low Middle Income Countries (LMIC). In Fiji, though sepsis is common, the use of the qSOFA score or any other screening tool for the diagnosis of sepsis is not well established in the ED. However, most clinicians rely on the gestalt to diagnose patients with sepsis.
OBJECTIVE: The aim of this study is to assess the efficacy of the qSOFA and compare this to the clinician gestalt to accurately predict in hospital mortality.
METHODS: This is a prospective study conducted in the Emergency Department (ED) of a tertiary teaching hospital, the Colonial War Memorial Hospital (CWMH) from May to July 2019. Adult patients, 18 years and above presenting to the ED with suspected infections were included in the study and followed up 30 days later for in hospital mortality, the use of inotropes or admissions into acute wards or the Intensive Care Unit (ICU).
RESULTS: There were 130 patients recruited for the study. 109 patients were followed up for analysis. The mean age of the study population was 48years with a median age of 66years. The I-taukei ethnicity (73%) represented majority of the population. 41.3% of patients had comorbidities and respiratory as a suspected source of clinical infection. The overall in hospital mortality was 11.9% with a 7.8% for those with a qSOFA of less than 2 vs 31.6% for those with a qSOFA of ≥ 2. The qSOFA performed better in predicting in hospital mortality (sensitivity 60%, specificity 86%) as compared to the clinician gestalt (sensitivity 41% vs specificity 57%).
CONCLUSION: This study supports the new sepsis definition in that the qSOFA can be used in the ED to predict in hospital mortality for patients presenting with suspected infection.