Sepsis screening tools ‘inadequate’, researchers say

Half the screening tools used by emergency medics to detect sepsis in patients have been labelled “inadequate” by researchers.

Experts said more must be done to support emergency services and improve existing systems to bring down death rates from blood poisoning.

A German study explored the effectiveness of four internationally-recommended screening tools for the illness – NEWS-2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome).

Using data from 10 health insurance companies, the team collected a cohort of 221,429 patients who were seen by emergency medical services in Germany in 2016 outside of a hospital setting, with individual follow-ups in 2016 and 2017.

They also looked at documents from paramedics on 110,419 cases from 2016.

Linking the figures together allowed a calculation of the screening tools’ ability to predict sepsis, which was found in 4,504 adult cases.

However, researchers said only one of the four systems “had a reasonably accurate prediction rate”.

NEWS-2 – which gives a score for illness severity and risk of deterioration – had the highest sensitivity rate at 72.7%.

NEWS was initially developed by the Royal College of Physicians and was updated to NEWS-2 in 2017.

It is the screening tool endorsed by NHS England and is used by all ambulance trusts and 76% of acute trusts.

NEWS-2 was followed by MEWS, with a 46.8% sensitivity, and SIRS (30.4%).

The qSOFA system, which scores patients on their breathing, mental state and blood pressure, had the lowest sensitivity rate at 24.1%, but correctly predicted 96.6% of patients who did not have sepsis.

Silke Piedmont, a health scientist at the Department of Emergency Medicine Campus Benjamin Franklin Charite – Universitatsmedizin Berlin, said: “We found that paramedics never documented a suspicion of sepsis and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases.

“The screening tools recommended in the Surviving Sepsis Campaign guidelines differed greatly in terms of which and how many patients were identified as possibly having sepsis.”

According to Health Education England, there are about 123,000 cases of sepsis each year in England, with about 36,800 associated deaths.

It is hoped the findings – which will be presented at the European Emergency Medicine Congress (EUSEM 2023) – could apply to other countries and work towards the development of new guidelines on sepsis screening.

Mrs Piedmont added: “The incidence and death rates for sepsis and the low recognition of it emphasise the need for better awareness and more frequent use of screening tools.

“No screening tool provides ideal performance.

“Ours is the first study comparing all four screening tools and showing the predictive usefulness of applying the screening tools to all adult patients independently of any presumptions or preliminary diagnoses by emergency medical services.”

The study comes after the UK Government committed to implementing “Martha’s rule” in England.

Merope Mills’ daughter Martha died in 2021 at the age of 13 after developing sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

The rule will give patients the right to a second opinion if they believe their concerns are being dismissed by NHS staff.

A spokesperson for the UK Sepsis Trust said: “Sepsis screening is an integral part of improving outcomes from Sepsis.

“In the UK, we do have the advantage of the NEWS-2 screening tool which has performed well in the study.

“Of the other screening tools assessed, only qSOFA is used to any degree in the UK, though it shouldn’t be: for organisations using nationally approved tracking trigger warning system such as NEWS-2 this was strongly recommended against by the international academic guidelines committee, the Surviving Sepsis Campaign, in October 2021.

“None of these tools would apply to children like Martha Mills. Neither would they diagnose sepsis, they simply indicate a higher risk of poor outcome with infection.

“Our recommendation is to use a combination of clinical acumen with NEWS-2 to identify those patients at a higher risk of deterioration with infection, with either the presence of a red flag or a NEWS-2 score of seven or above to identify those patients to be treated as sepsis.”

Professor Youri Yordanov, chairman of the EUSEM 2023 abstract committee, said: “Sadly, we too often see patients being brought into hospital emergency departments with advanced sepsis.

“Some of them we can save, but unfortunately some will die who could have been saved if they had received treatment at an earlier stage.

“Emergency services need tools that can help them quickly and accurately predict that a patient may have sepsis and should be investigated further in hospital.

“This study shows that more needs to be done to develop such tools and improve the existing ones. Only then will we be able to bring down the death rates from sepsis.”