Prognostic Accuracy of News2 and Qsofa for Predicting In-Hospital Mortality in Emergency Department Patients with Suspected Sepsis

Background: Proactive risk evaluation is crucial for bettering prognoses in those with suspected sepsis entering the emergency room. Although the National Early Warning Score 2 (NEWS2) and the rapid Sequential Organ Failure Assessment (qSOFA) are extensively utilized as bedside prognostic measures, their relative performance remains unclear. The objective is to compare the prognostic accuracy of NEWS2 and qSOFA in predicting in-hospital mortality among adult emergency department patients with suspected sepsis, with subsequent review of ICU admission and the requirement for mechanical ventilation. Material and Methods: Between June 2022 and June 2023, the Almadeena Institute of Medical Sciences' Department of Emergency Medicine in Kerala, India, carried out this prospective observational study. A total of 400 adult patients with suspected sepsis were enrolled. NEWS2 and qSOFA scores were calculated at presentation and repeated one hour after emergency department admission. The prognostic performance of both scoring systems was assessed using receiver operating characteristic (ROC) curve analysis in order to predict 24-hour mortality, 3-day mortality, ICU admission, and the requirement for mechanical ventilation. Results: Non-survivors were older, predominantly male, and more frequently had lower respiratory tract infections, diabetes mellitus, and hypertension. They demonstrated poorer physiological parameters, higher oxygen requirements, and greater rates of ICU admission and mechanical ventilation. Both NEWS2 and qSOFA scores were significantly higher among non-survivors at presentation and one hour after admission. At presentation, both scores showed comparable discrimination for predicting 24-hour mortality, 3-day mortality, and the need for mechanical ventilation, whereas NEWS2 demonstrated superior discrimination for ICU admission (AUROC 0.970 vs. 0.926). At one hour, for predicting 3-day death (AUROC 0.915 vs. 0.880), mechanical ventilation (AUROC 0.931 vs. 0.884), and ICU admission (AUROC 0.972 vs. 0.931), NEWS2 outperformed qSOFA in terms of prognostic accuracy; however, both scores were similar for predicting 24-hour mortality. Conclusion: When an adult patient presents to the emergency room with suspected sepsis, NEWS2 and qSOFA are both helpful bedside instruments for early risk assessment. When reviewed an hour after presentation, NEWS2 showed greater predictive accuracy than qSOFA for predicting ICU admission, mechanical ventilation, and short-term death.

Keywords: Sepsis; NEWS2; qSOFA; Emergency Department; Risk Stratification; In-Hospital Mortality; Intensive Care Unit.