Prognostic performance of Emergency Severity Index (ESI) combined with qSOFA score

Abstract

Objective: We conducted this study to investigate whether ESI combined with qSOFA score (ESI + qSOFA) predicts hospital outcome better than ESI alone in the emergency department (ED). Methods: This was a retrospective study for patients aged over 15 years who visited an ED of a tertiary referral hospital from January 1st, 2015 to December 31st, 2015. We calculated and compared predictive performances of ESI alone and ESI + qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the secondary outcome was composite outcome of in-hospital mortality and ICU admission. We calculated inhospital mortality rates by positive qSOFA in each subgroup divided according to ESI levels (1, 2, 3, 4 + 5). Results: 43,748 patients were enrolled. The area under receiver-operating characteristics curves were higher in ESI + qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777, P < .001 for mortality; 0.778 vs. 0.774, P < .001 for composite outcome). In each subgroup divided by ESI levels, patients with positive qSOFA had significantly higher in-hospital mortality rate compared to those with negative qSOFA (20.4% vs. 14.7%, P = .117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P = .001 in ESI level 2 subgroup; 23% vs. 0.4%, P < .001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup). Conclusion: The prognostic performance of ESI + qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within each subgroup, patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA. (C) 2018 Elsevier Inc. All rights reserved.