Evidence map›Paper›PMID 29632083›Full record

ArticleBMJ open2018

Sepsis recognition tools in acute ambulatory care: associations with process of care and clinical outcomes in a service evaluation of an Emergency Multidisciplinary Unit in Oxfordshire.

Christian Fielder Camm, Gail Hayward, Tania C N Elias, Jordan S T Bowen, Roya Hassanzadeh, Thomas Fanshawe, Sarah T Pendlebury, Daniel S Lasserson

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

Christian Fielder CammRadcliffe Department of Medicine, University of Oxford, Oxford, UK.
Gail HaywardNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Tania C N EliasEmergency Multidisciplinary Unit, Abingdon Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
Jordan S T BowenEmergency Multidisciplinary Unit, Abingdon Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
Roya HassanzadehDepartment of Public Health and Primary Care, Imperial College London, London, UK.
Thomas FanshaweNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Sarah T PendleburyDepartment of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK.ORCID 0000-0003-3603-8388
Daniel S LassersonDepartment of Geratology, Oxford University Hospitals NHS Foundation Trust, London, UK.ORCID 0000-0001-8274-5580
University of Oxford · GBOxford Health NHS Foundation Trust · GBImperial College London · GBJohn Radcliffe Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the performance of currently available sepsis recognition tools in patients referred to a community-based acute ambulatory care unit.

designService evaluation of consecutive patients over a 4-month period.

settingCommunity-based acute ambulatory care unit. DATA COLLECTION AND OUTCOME MEASURES: Observations, blood results and outcome data were analysed from patients with a suspected infection. Clinical features at first assessment were used to populate sepsis recognition tools including: systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA) and National Institute for Health and Care Excellence (NICE) criteria. Scores were assessed against the clinical need for escalated care (use of intravenous antibiotics, fluids, ongoing ambulatory care or hospital treatment) and poor clinical outcome (all-cause mortality and readmission at 30 days after index assessment).

resultsOf 533 patients (median age 81 years), 316 had suspected infection with 120 patients requiring care escalated beyond simple community care. SIRS had the highest positive predictive value (50.9%, 95% CI 41.6% to 60.3%) and negative predictive value (68.9%, 95% CI 62.6% to 75.3%) for the need for escalated care. Both NEWS and SIRS were better at predicting the need for escalated care than qSOFA and NICE criteria in patients with suspected infection (all P<0.001). While new-onset confusion predicted the need for escalated care for infection in patients ≥85 years old (n=114), 23.7% of patients ≥85 years had new-onset confusion without evidence for infection.

conclusionsAcute ambulatory care clinicians should use caution in applying the new NICE endorsed criteria for determining the need for intravenous therapy and hospital-based location of care. NICE criteria have poorer performance when compared against NEWS and SIRS and new-onset confusion was prevalent in patients aged ≥85 years without infection.

Indexed as

Emergency Service, HospitalOrgan Dysfunction ScoresSepsisSystemic Inflammatory Response SyndromeAged, 80 and overAmbulatory CareFemaleHospital MortalityHumansMaleepidemiologygeneral medicine (see internal medicine)geriatric medicinequality in health care

Identifiers

PMID29632083
PMCPMC5892763
OpenAlexW2798105817

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.