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Quick Sequential Organ Failure Assessment Score and the Modified Early Warning Score for Predicting Clinical Deterioration in General Ward Patients Regardless of Suspected Infection.
Ko, Ryoung-Eun; Kwon, Oyeon; Cho, Kyung-Jae; Lee, Yeon Joo; Kwon, Joon-Myoung; Park, Jinsik; Kim, Jung Soo; Kim, Ah Jin; Jo, You Hwan; Lee, Yeha; Jeon, Kyeongman.
Affiliation
  • Ko RE; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • Kwon O; VUNO, Seoul, Korea.
  • Cho KJ; VUNO, Seoul, Korea.
  • Lee YJ; Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • Kwon JM; Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital, Incheon, Korea.
  • Park J; Division of Cardiology, Cardiovascular Center, Mediplex Sejong Hospital, Incheon, Korea.
  • Kim JS; Division of Critical Care Medicine, Department of Hospital Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
  • Kim AJ; Division of Critical Care Medicine, Department of Hospital Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
  • Jo YH; Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • Lee Y; VUNO, Seoul, Korea.
  • Jeon K; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kjeon@skku.edu.
J Korean Med Sci ; 37(16): e122, 2022 Apr 25.
Article in En | MEDLINE | ID: mdl-35470597
BACKGROUND: The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. METHODS: The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. RESULTS: Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777; 95% confidence interval [CI], 0.770-0.781) was higher than that for qSOFA (AUC, 0.684; 95% CI, 0.676-0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781-0.795 vs. AUC, 0.640; 95% CI, 0.625-0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760-0.773 vs. AUC, 0.716; 95% CI, 0.707-0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. CONCLUSION: MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sepsis / Clinical Deterioration / Early Warning Score Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Humans Language: En Journal: J Korean Med Sci Journal subject: MEDICINA Year: 2022 Document type: Article Country of publication: Korea (South)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Sepsis / Clinical Deterioration / Early Warning Score Type of study: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adult / Humans Language: En Journal: J Korean Med Sci Journal subject: MEDICINA Year: 2022 Document type: Article Country of publication: Korea (South)