{"title":"验证和比较基于分流的败血症筛查策略","authors":"","doi":"10.1016/j.ajem.2024.08.037","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage.</p></div><div><h3>Methods</h3><p>This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to use at ED triage based on their area under the precision-recall curve (AUPRC, which balances positive predictive value and sensitivity) and area under the receiver operator characteristic curve (AUROC, which balances sensitivity and specificity). Score performance for predicting whether patients met Sepsis-3 criteria in the ED was compared to patients' assigned ED triage score (Canadian Triage Acuity Score [CTAS]) with adjustment for multiple comparisons.</p></div><div><h3>Results</h3><p>Among 2000 case/control patients, 981 met Sepsis-3 criteria on final adjudication. The best performing sepsis risk scores were the Predict Sepsis version #3 (AUPRC 0.183, 95 % CI 0.148–0.256; AUROC 0.859, 95 % CI 0.843–0.875) and Borelli scores (AUPRC 0.127, 95 % CI 0.107–0.160, AUROC 0.845, 95 % CI 0.829–0.862), which significantly outperformed CTAS (AUPRC 0.038, 95 % CI 0.035–0.042, AUROC 0.650, 95 % CI 0.628–0.671, <em>p</em> < 0.001 for all AUPRC and AUROC comparisons). The Predict Sepsis and Borelli scores exhibited sensitivity of 0.670 and 0.678 and specificity of 0.902 and 0.834, respectively, at their recommended cutoff values and outperformed Systemic Inflammatory Response Syndrome (SIRS) criteria (AUPRC 0.083, 95 % CI 0.070–0.102, <em>p</em> = 0.052 and <em>p</em> = 0.078, respectively; AUROC 0.775, 95 % CI 0.756–0.795, <em>p</em> < 0.001 for both scores).</p></div><div><h3>Conclusions</h3><p>The Predict Sepsis and Borelli scores exhibited improved performance including increased specificity and positive predictive values for sepsis identification at ED triage compared to CTAS and SIRS criteria.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Validation and comparison of triage-based screening strategies for sepsis\",\"authors\":\"\",\"doi\":\"10.1016/j.ajem.2024.08.037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage.</p></div><div><h3>Methods</h3><p>This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to use at ED triage based on their area under the precision-recall curve (AUPRC, which balances positive predictive value and sensitivity) and area under the receiver operator characteristic curve (AUROC, which balances sensitivity and specificity). Score performance for predicting whether patients met Sepsis-3 criteria in the ED was compared to patients' assigned ED triage score (Canadian Triage Acuity Score [CTAS]) with adjustment for multiple comparisons.</p></div><div><h3>Results</h3><p>Among 2000 case/control patients, 981 met Sepsis-3 criteria on final adjudication. The best performing sepsis risk scores were the Predict Sepsis version #3 (AUPRC 0.183, 95 % CI 0.148–0.256; AUROC 0.859, 95 % CI 0.843–0.875) and Borelli scores (AUPRC 0.127, 95 % CI 0.107–0.160, AUROC 0.845, 95 % CI 0.829–0.862), which significantly outperformed CTAS (AUPRC 0.038, 95 % CI 0.035–0.042, AUROC 0.650, 95 % CI 0.628–0.671, <em>p</em> < 0.001 for all AUPRC and AUROC comparisons). The Predict Sepsis and Borelli scores exhibited sensitivity of 0.670 and 0.678 and specificity of 0.902 and 0.834, respectively, at their recommended cutoff values and outperformed Systemic Inflammatory Response Syndrome (SIRS) criteria (AUPRC 0.083, 95 % CI 0.070–0.102, <em>p</em> = 0.052 and <em>p</em> = 0.078, respectively; AUROC 0.775, 95 % CI 0.756–0.795, <em>p</em> < 0.001 for both scores).</p></div><div><h3>Conclusions</h3><p>The Predict Sepsis and Borelli scores exhibited improved performance including increased specificity and positive predictive values for sepsis identification at ED triage compared to CTAS and SIRS criteria.</p></div>\",\"PeriodicalId\":55536,\"journal\":{\"name\":\"American Journal of Emergency Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0735675724004315\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0735675724004315","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
方法这项巢式病例/对照研究从犹他州的四家医院招募了急诊科患者,并根据精确度-召回曲线下面积(AUPRC,兼顾阳性预测值和灵敏度)和接收者运算特征曲线下面积(AUROC,兼顾灵敏度和特异性)评估了之前发表的适合在急诊科分诊时使用的脓毒症风险评分的性能。将预测患者在急诊室是否符合败血症-3 标准的评分性能与患者指定的急诊室分诊评分(加拿大分诊急性症状评分 [CTAS])进行了比较,并对多重比较进行了调整。结果在 2000 名病例/对照患者中,有 981 人在最终裁定时符合败血症-3 标准。表现最好的脓毒症风险评分是脓毒症预测 3 版(AUPRC 0.183,95 % CI 0.148-0.256;AUROC 0.859,95 % CI 0.843-0.875)和 Borelli 评分(AUPRC 0.127,95 % CI 0.107-0.160,AUROC 0.845,95 % CI 0.829-0.862),明显优于 CTAS(AUPRC 0.038,95 % CI 0.035-0.042,AUROC 0.650,95 % CI 0.628-0.671,所有 AUPRC 和 AUROC 比较 p <0.001)。脓毒症预测评分和 Borelli 评分在其推荐临界值下的灵敏度分别为 0.670 和 0.678,特异性分别为 0.902 和 0.834,优于系统炎症反应综合征(SIRS)标准(AUPRC 0.083, 95 % CI 0.070-0.102, p = 0.052 和 p = 0.结论与 CTAS 和 SIRS 标准相比,Predict Sepsis 和 Borelli 评分的性能有所提高,包括在急诊室分诊时识别败血症的特异性和阳性预测值均有所提高。
Validation and comparison of triage-based screening strategies for sepsis
Objective
This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage.
Methods
This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to use at ED triage based on their area under the precision-recall curve (AUPRC, which balances positive predictive value and sensitivity) and area under the receiver operator characteristic curve (AUROC, which balances sensitivity and specificity). Score performance for predicting whether patients met Sepsis-3 criteria in the ED was compared to patients' assigned ED triage score (Canadian Triage Acuity Score [CTAS]) with adjustment for multiple comparisons.
Results
Among 2000 case/control patients, 981 met Sepsis-3 criteria on final adjudication. The best performing sepsis risk scores were the Predict Sepsis version #3 (AUPRC 0.183, 95 % CI 0.148–0.256; AUROC 0.859, 95 % CI 0.843–0.875) and Borelli scores (AUPRC 0.127, 95 % CI 0.107–0.160, AUROC 0.845, 95 % CI 0.829–0.862), which significantly outperformed CTAS (AUPRC 0.038, 95 % CI 0.035–0.042, AUROC 0.650, 95 % CI 0.628–0.671, p < 0.001 for all AUPRC and AUROC comparisons). The Predict Sepsis and Borelli scores exhibited sensitivity of 0.670 and 0.678 and specificity of 0.902 and 0.834, respectively, at their recommended cutoff values and outperformed Systemic Inflammatory Response Syndrome (SIRS) criteria (AUPRC 0.083, 95 % CI 0.070–0.102, p = 0.052 and p = 0.078, respectively; AUROC 0.775, 95 % CI 0.756–0.795, p < 0.001 for both scores).
Conclusions
The Predict Sepsis and Borelli scores exhibited improved performance including increased specificity and positive predictive values for sepsis identification at ED triage compared to CTAS and SIRS criteria.
期刊介绍:
A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.