Abstract
Background
There is no universal trigger or tool to aid sepsis diagnosis.
Objectives
The objective of this study was to identify triggers and tools to assist the early
detection of sepsis that can be readily implemented across various health care settings.
Methods
A systematic integrative review was conducted using MEDLINE, CINAHL, EMBASE, Scopus,
and the Cochrane Database of Systematic Reviews. Relevant grey literature and subject-matter
expert consultation also informed the review. Study types included systematic reviews,
randomised controlled trials, and cohort studies. All patient populations across prehospital,
emergency department, and acute hospital inpatient settings, excluding the intensive
care unit, were included. Sepsis triggers and tools were evaluated for efficacy in
detecting sepsis and association with process measures and patient outcomes. Methodological
quality was appraised using Joanna Briggs Institute tools.
Results
Of the 124 included studies, most were retrospective cohort (49.2%) in adults (83.9%)
within the emergency department (44.4%). The most commonly evaluated sepsis tools
were qSOFA (12 studies) and SIRS (11 studies) with a median sensitivity of 28.0% versus
51.0% and a specificity of 98.0% versus 82.0%, respectively, for sepsis diagnosis.
Lactate plus qSOFA (two studies) had a sensitivity between 57.0 and 65.5%, whereas
the National Early Warning Score (four studies) demonstrated median sensitivity and
specificity >80%, but the latter was considered difficult to implement. Amongst triggers,
lactate (18 studies) at the threshold of ≥2.0 mmol/L showed higher sensitivity for
predicting sepsis-related clinical deterioration than <2.0 mmol/L. Automated sepsis
alerts and algorithms (35 studies) showed median sensitivity between 58.0 and 80.0%
and specificity between 60.0 and 93.1%. There were limited data for other sepsis tools
and maternal, paediatric, and neonatal populations. Overall methodological quality
was high.
Conclusion
No single sepsis tool or trigger is applicable across various settings and populations,
but considering efficacy and ease of implementation, there is evidence to use lactate
plus qSOFA for adult patients. More research is needed in maternal, paediatric, and
neonatal populations.
Keywords
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Article info
Publication history
Published online: February 20, 2023
Accepted:
January 9,
2023
Received in revised form:
January 9,
2023
Received:
June 21,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
