Top

Published in:

Open Access 01-12-2024 | Septic Shock | Research

The prehospital NEW score to assess septic shock in-hospital, 30-day and 90-day mortality

Authors: Romain Jouffroy, Florian Négrello, Jean Limery, Basile Gilbert, Stéphane Travers, Emmanuel Bloch-Laine, Patrick Ecollan, Josiane Boularan, Vincent Bounes, Benoit Vivien, Papa Gueye

Published in: BMC Infectious Diseases | Issue 1/2024

Abstract

Background

The early identification of sepsis presenting a high risk of deterioration is a daily challenge to optimise patient pathway. This is all the most crucial in the prehospital setting to optimize triage and admission into the appropriate unit: emergency department (ED) or intensive care unit (ICU). We report the association between the prehospital National Early Warning Score 2 (NEWS-2) and in-hospital, 30 and 90-day mortality of SS patients cared for in the pre-hospital setting by a mobile ICU (MICU).

Methods

Septic shock (SS) patients cared for by a MICU between 2016, April 6th and 2021 December 31st were included in this retrospective cohort study. The NEWS-2 is based on 6 physiological variables (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation prior oxygen supplementation, and level of consciousness) and ranges from 0 to 20. The Inverse Probability Treatment Weighting (IPTW) propensity method was applied to assess the association with in-hospital, 30 and 90-day mortality. A NEWS-2 ≥ 7 threshold was chosen for increased clinical deterioration risk definition and usefulness in clinical practice based on previous reports.

Results

Data from 530 SS patients requiring MICU intervention in the pre-hospital setting were analysed. The mean age was 69 ± 15 years and presumed origin of sepsis was pulmonary (43%), digestive (25%) or urinary (17%) infection. In-hospital mortality rate was 33%, 30 and 90-day mortality were respectively 31% and 35%. A prehospital NEWS-2 ≥ 7 is associated with an increase in-hospital, 30 and 90-day mortality with respective RRa = 2.34 [1.39–3.95], 2.08 [1.33–3.25] and 2.22 [1.38–3.59]. Calibration statistic values for in-hospital mortality, 30-day and 90-day mortality were 0.54; 0.55 and 0.53 respectively.

Conclusion

A prehospital NEWS-2 ≥ 7 is associated with an increase in in-hospital, 30 and 90-day mortality of septic shock patients cared for by a MICU in the prehospital setting. Prospective studies are needed to confirm the usefulness of NEWS-2 to improve the prehospital triage and orientation to the adequate facility of sepsis.

Ferrer R, Artigas A, Levy MM, Blanco J, Gonzalez-Diaz G, Garnacho-Montero J, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA. 2008;299(19):2294–303.PubMedCrossRef

Nguyen HB, Van Ginkel C, Batech M, Banta J, Corbett SW. Comparison of predisposition, Insult/Infection, response, and organ dysfunction, Acute Physiology and Chronic Health evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. J Crit Care. 2012;27(4):362–9.PubMedCrossRef

Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the global burden of Disease Study. Lancet. 2020;395(10219):200–11.PubMedPubMedCentralCrossRef

Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54.PubMedCrossRef

Weng L, Zeng XY, Yin P, Wang LJ, Wang CY, Jiang W, et al. Sepsis-related mortality in China: a descriptive analysis. Intensive Care Med. 2018;44(7):1071–80.PubMedCrossRef

Vincent JL, Jones G, David S, Olariu E, Cadwell KK. Frequency and mortality of septic shock in Europe and North America: a systematic review and meta-analysis. Crit Care. 2019;23(1):196.PubMedPubMedCentralCrossRef

ASSEMBLY SWH. Improving the prevention, diagnosis and clinical management of sepsis. 2017.

Epstein L, Dantes R, Magill S, Fiore A. Varying estimates of Sepsis Mortality using death certificates and administrative codes–United States, 1999–2014. MMWR Morb Mortal Wkly Rep. 2016;65(13):342–5.PubMedCrossRef

Medicine SoCC. Surviving sepsis campaign: updated bundles in response to new evidence. Mount Prospect, IL. Surviving Sepsis Campaign;. 2015(Apr).

10.

Leisman DE, Doerfler ME, Ward MF, Masick KD, Wie BJ, Gribben JL, et al. Survival benefit and cost savings from compliance with a simplified 3-Hour Sepsis bundle in a series of prospective, multisite, observational cohorts. Crit Care Med. 2017;45(3):395–406.PubMedCrossRef

11.

Esteban A, Frutos-Vivar F, Ferguson ND, Penuelas O, Lorente JA, Gordo F, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med. 2007;35(5):1284–9.PubMedCrossRef

12.

Jouffroy R, Pierre Tourtier J, Gueye P, Bloch-Laine E, Bounes V, Debaty G et al. Prehospital shock index to assess 28-day mortality for septic shock. Am J Emerg Med. 2019.

13.

Jouffroy R, Saade A, Tourtier JP, Gueye P, Bloch-Laine E, Ecollan P, et al. Skin mottling score and capillary refill time to assess mortality of septic shock since pre-hospital setting. Am J Emerg Med. 2019;37(4):664–71.PubMedCrossRef

14.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.PubMedPubMedCentralCrossRef

15.

Jouffroy R, Saade A, Carpentier A, Ellouze S, Philippe P, Idialisoa R, et al. Triage of septic patients using qSOFA criteria at the SAMU Regulation: a retrospective analysis. Prehosp Emerg Care. 2018;22(1):84–90.PubMedCrossRef

16.

Jouffroy R, Saade A, Ellouze S, Carpentier A, Michaloux M, Carli P, et al. Prehospital triage of septic patients at the SAMU regulation: comparison of qSOFA, MRST, MEWS and PRESEP scores. Am J Emerg Med. 2018;36(5):820–4.PubMedCrossRef

17.

Physicians RCo. National Early Warning Score (NEWS) 2. Standardising the assessment of acute-illnessseverity in the NHS. 2017.

18.

Smith GB, Prytherch DR, Jarvis S, Kovacs C, Meredith P, Schmidt PE, et al. A comparison of the ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early warning score to discriminate patients at risk of a range of adverse clinical outcomes. Crit Care Med. 2016;44(12):2171–81.PubMedCrossRef

19.

Smith GB, Prytherch DR, Schmidt P, Featherstone PI, Knight D, Clements G, et al. Hospital-wide physiological surveillance-a new approach to the early identification and management of the sick patient. Resuscitation. 2006;71(1):19–28.PubMedCrossRef

20.

Albur M, Hamilton F, MacGowan AP. Early warning score: a dynamic marker of severity and prognosis in patients with Gram-negative bacteraemia and sepsis. Ann Clin Microbiol Antimicrob. 2016;15:23.PubMedPubMedCentralCrossRef

21.

Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K, et al. Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive Care Med. 2007;33(4):667–79.PubMedCrossRef

22.

Keep JW, Messmer AS, Sladden R, Burrell N, Pinate R, Tunnicliff M, et al. National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study. Emerg Med J. 2016;33(1):37–41.PubMedCrossRef

23.

Silcock DJ, Corfield AR, Gowens PA, Rooney KD. Validation of the National Early warning score in the prehospital setting. Resuscitation. 2015;89:31–5.PubMedCrossRef

24.

Shaw J, Fothergill RT, Clark S, Moore F. Can the prehospital national early warning score identify patients most at risk from subsequent deterioration? Emerg Med J. 2017;34(8):533–7.PubMedCrossRef

25.

Badriyah T, Briggs JS, Meredith P, Jarvis SW, Schmidt PE, Featherstone PI, et al. Decision-tree early warning score (DTEWS) validates the design of the National Early warning score (NEWS). Resuscitation. 2014;85(3):418–23.PubMedCrossRef

26.

Jouffroy R, Saade A, Muret A, Philippe P, Michaloux M, Carli P, et al. Fluid resuscitation in pre-hospital management of septic shock. Am J Emerg Med. 2018;36(10):1754–8.PubMedCrossRef

27.

Jouffroy R, Gilbert B, Tourtier JP, Bloch-Laine E, Ecollan P, Boularan J, et al. Prehospital Bundle of Care based on antibiotic therapy and hemodynamic optimization is Associated with a 30-Day mortality decrease in patients with septic shock. Crit Care Med. 2022;50(10):1440–8.PubMedCrossRef

28.

Adnet F, Lapostolle F. International EMS systems: France. Resuscitation. 2004;63(1):7–9.PubMedCrossRef

29.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.PubMedCrossRef

30.

Gearing RE, Mian IA, Barber J, Ickowicz A. A methodology for conducting retrospective chart review research in child and adolescent psychiatry. J Can Acad Child Adolesc Psychiatry. 2006;15(3):126–34.PubMedPubMedCentral

31.

Le Gall JR, Lemeshow S, Saulnier F. A new simplified Acute Physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270(24):2957–63.PubMedCrossRef

32.

Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology. 2000;11(5):550–60.PubMedCrossRef

33.

Hogan H, Healey F, Neale G, Thomson R, Vincent C, Black N. Preventable deaths due to problems in care in English acute hospitals: a retrospective case record review study. BMJ Qual Saf. 2012;21(9):737–45.PubMedPubMedCentralCrossRef

34.

Chen AX, Simpson SQ, Pallin DJ. Sepsis guidelines. N Engl J Med. 2019;380(14):1369–71.PubMedCrossRef

35.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063–e143.PubMedCrossRef

36.

Jouffroy R, Gueye P. Intensive care unit versus high-dependency care unit admission on mortality in patients with septic shock: let’s think to the survival chain concept for septic shock. J Intensive Care. 2022;10(1):52.PubMedPubMedCentralCrossRef

37.

Cannesson M, Le Manach Y, Hofer CK, Goarin JP, Lehot JJ, Vallet B, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a gray zone approach. Anesthesiology. 2011;115(2):231–41.PubMedCrossRef

38.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.PubMedCrossRef

39.

Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med. 2003;31(3):670–5.PubMedCrossRef

40.

Marshall JC. The PIRO (predisposition, insult, response, organ dysfunction) model: toward a staging system for acute illness. Virulence. 2014;5(1):27–35.PubMedCrossRefADS

41.

Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A, et al. Prognostic accuracy of Sepsis-3 criteria for In-Hospital mortality among patients with suspected infection presenting to the Emergency Department. JAMA. 2017;317(3):301–8.PubMedCrossRef

42.

Vafaei A, Heydari K, Hashemi-Nazari SS, Izadi N, Hassan Zadeh H. PIRO, SOFA and MEDS scores in Predicting one-Month Mortality of Sepsis patients; a diagnostic accuracy study. Arch Acad Emerg Med. 2019;7(1):e59.PubMedPubMedCentral

43.

Askim A, Moser F, Gustad LT, Stene H, Gundersen M, Asvold BO, et al. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med. 2017;25(1):56.PubMedPubMedCentralCrossRef

44.

Finkelsztein EJ, Jones DS, Ma KC, Pabon MA, Delgado T, Nakahira K, et al. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the intensive care unit. Crit Care. 2017;21(1):73.PubMedPubMedCentralCrossRef

45.

Guirgis FW, Jones L, Esma R, Weiss A, McCurdy K, Ferreira J, et al. Managing sepsis: electronic recognition, rapid response teams, and standardized care save lives. J Crit Care. 2017;40:296–302.PubMedPubMedCentralCrossRef

46.

Diaconu K, Falconer J, Vidal N, O’May F, Azasi E, Elimian K, et al. Understanding fragility: implications for global health research and practice. Health Policy Plan. 2020;35(2):235–43.PubMedCrossRef

47.

Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15.PubMedPubMedCentralCrossRef

48.

Blot S, Cankurtaran M, Petrovic M, Vandijck D, Lizy C, Decruyenaere J, et al. Epidemiology and outcome of nosocomial bloodstream infection in elderly critically ill patients: a comparison between middle-aged, old, and very old patients. Crit Care Med. 2009;37(5):1634–41.PubMedCrossRef

49.

Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34(1):15–21.PubMedCrossRef

50.

Muscedere J, Waters B, Varambally A, Bagshaw SM, Boyd JG, Maslove D, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta-analysis. Intensive Care Med. 2017;43(8):1105–22.PubMedPubMedCentralCrossRef

Title: The prehospital NEW score to assess septic shock in-hospital, 30-day and 90-day mortality
Authors: Romain Jouffroy
Florian Négrello
Jean Limery
Basile Gilbert
Stéphane Travers
Emmanuel Bloch-Laine
Patrick Ecollan
Josiane Boularan
Vincent Bounes
Benoit Vivien
Papa Gueye
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Septic Shock
Septicemia
Septicemia
Triage
Published in: BMC Infectious Diseases / Issue 1/2024
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-024-09104-7

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Prevalence of misconception about HIV/AIDS transmission and associated factors among reproductive age women in Ethiopia: a nationwide study

HIV self-testing adoption and post-test linkage to care among men who have sex with men in China: a nationwide cross-sectional survey

Bacterial contamination on clinical surfaces and oxygen device accessories in the emergency unit of a tertiary health facility in Ghana

Computer-aided designing of a novel multi‑epitope DNA vaccine against severe fever with thrombocytopenia syndrome virus

First COVID-19 wave in the province of Bergamo, Italy: epidemiological and clinical characteristics, outcome and management of the first hospitalized patients

Development of a novel dynamic nosocomial infection risk management method for COVID-19 in outpatient settings

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials