Common Assessment Poorly Supports Sepsis Diagnosis in Older Inpatients
FOR IMMEDIATE RELEASE
May 10, 2022
Contact: Ellen Mullally
Older adults are more prone to develop sepsis, a potentially life-threatening clinical syndrome, and suffer negative consequences such as disability, subsequent institutionalization, and even death. However, according to a study in the May issue of JAMDA, repeated qSOFA (quick sequential organ failure assessment) determinants perform poorly to identify sepsis in geriatric inpatients with suspected infections.
In Comparison of Diagnostic Accuracies of qSOFA, NEWS, and MEWS to Identify Sepsis in Older Inpatients with Suspected Infection, the authors found that among 230 geriatric patients with suspected infection, 30.9% had a sepsis diagnosis. A qSOFA was recorded in 48.3% of patients, a MEWS in 28.3%, and a NEWS in 50%. The qSOFA showed the highest sensitivity and low specificity, resulting in a high negative predictive value (NPV) and poor positive predictive value (PPV). The authors concluded that repeated qSOFA determinations may be useful to rule out sepsis in geriatric inpatients with a suspected infection, but they offer poor diagnostic support. And the more complex MEWS and NEWS assessments don’t perform any better.
The authors suggested, “qSOFA should be seen more as a ‘red flag’ to identify at-risk patients rather than as a diagnostic tool in this population.” They added, “Clinical reasoning, including evaluation of functional manifestation of disease and geriatric syndromes should guide further diagnostic and therapeutic measures.” However, they also observed that the use of more complex and time-consuming MEWS and NEWS does not provide a significant benefit over the simpler qSOFA.
This issue must be studied further, the authors stressed, as sepsis is fatal in 30-60% of inpatients aged 65 and older and in 40-80% of patients 80 or older. They noted that while this excess mortality is probably due to the generally worse overall health and functional status of older patients, part of it may be attributed to delayed diagnosis and treatment. This delay is often because of “low clinical suspicion and atypical and subtle presentation.”
The study was conducted by researchers at the Department of Medical Sciences, Universita degli Studi di Torino, Section of Geriatrics, Torino, Italy.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.