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Prognostic value of prehospital quick sequential organ failure assessment score among patients with suspected infection

Vaittinada Ayar, Prabakara,b; Delay, Mathieub; Avondo, Aurélied; Duchateau, François-Xaviere; Nadiras, Pierref; Lapostolle, Frédéricg; Chouihed, Taharh; Freund, Yonathanb,c

European Journal of Emergency Medicine: August 22, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MEJ.0000000000000570
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Objective After the third international consensus on sepsis released its new definitions, the prognostic value of quick sequential organ failure assessment (qSOFA) score has been confirmed in the emergency department. However, its validity in the prehospital setting remains unknown. The objective of the study was to assess its accuracy for prehospital patients cared by emergency physician-staffed ambulances (services mobiles d’urgence et de réanimation SMUR).

Patients and methods This was a prospective observational multicenter cohort study (N=6). All consecutive patients with prehospital clinical suspicion of infection by the emergency physician of the SMUR emergency medical service were included. Components of qSOFA were collected, and the patients were followed until hospital discharge. The primary end point was in-hospital mortality, censored at 28 days. Secondary end points included ICU admission longer than 72 h and a composite of ‘death or ICU stay more than 72 h’.

Results We screened 342 patients and included 332 in the analysis. Their mean age was 73 years, 159 (48%) were women, and the most common site of infection was respiratory (73% of cases). qSOFA was at least 2 in 133 (40%) patients. The overall in-hospital mortality was 27%: 41% in patients with qSOFA of at least 2 versus 18% for qSOFA less than 2 (absolute difference 23%; 95% confidence interval: 13–33%, P<0.001). The overall discrimination for qSOFA was poor, with an area under the receiver operating characteristic curve of 0.69 (95% confidence interval: 0.62–0.74).

Conclusion In this large multicenter study, prehospital qSOFA presents a strong association with mortality in infected patient, though with poor prognostic performances in our severely ill sample.

aEmergency Department, Hôpital Bichat

bEmergency Department and EMS, Pitié-Salpêtrière Hospital

cSorbonne Université, Paris, France

dEmergency Department and EMS, Centre Hospitalier Universitaire, Dijon

eEmergency Department and EMS, Hôpital Beaujon, Clichy

fEmergency Department and EMS, Hôpital Montfermeil

gEmergency Department and EMS, Hôpital Avicenne, Bobigny

hEmergency Department and EMS, Centre Hospitalier Universitaire, Nancy, France

Correspondence to Yonathan Freund, MD, Hôpital Pitié-Salpêtrière, 83 Boulevard de l’hôpital, 75013 Paris, France Tel: +33 1 8482 7129; e-mail: yonathan.freund@aphp.fr

Received November 22, 2017

Accepted February 18, 2018

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