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Early risk assessment of severe outcomes in patients with suspected infection in the emergency department using clinical scores in a multicenter international validation

Hincapié-Osorno, Carolina ; van der Aart, Tamar J. ; van Wijk, Raymond J. ; Föhse, Konstantin ; Hoogerwerf, Jacobien J. ; Jaimes, Fabián ; Koeze, Jacqueline ; Linder, Adam LU ; van Londen, Marco and ter Maaten, Jan C. , et al. (2026) In Journal of Infection and Public Health 19(4).
Abstract

Background: Early identification of patients with suspected infection who are at risk of clinical deterioration in the Emergency Department (ED) is challenging, yet crucial for timely initiation of appropriate care and prevention of clinical deterioration. This multicenter international study evaluates the performance of established scores (SIRS, LODS, qSOFA, SOFA, NEWS) in predicting severe outcomes in ED patients with suspected infection. Methods: We combined data from five different ED cohort studies (n = 4044 adult patients) from the Netherlands and Sweden. Suspected infection was defined as obtaining a microbiological culture combined with starting antibiotics. The scores were evaluated for their accuracy in predicting the... (More)

Background: Early identification of patients with suspected infection who are at risk of clinical deterioration in the Emergency Department (ED) is challenging, yet crucial for timely initiation of appropriate care and prevention of clinical deterioration. This multicenter international study evaluates the performance of established scores (SIRS, LODS, qSOFA, SOFA, NEWS) in predicting severe outcomes in ED patients with suspected infection. Methods: We combined data from five different ED cohort studies (n = 4044 adult patients) from the Netherlands and Sweden. Suspected infection was defined as obtaining a microbiological culture combined with starting antibiotics. The scores were evaluated for their accuracy in predicting the composite outcome of intensive care unit (ICU) admission and in-hospital mortality. Findings: Of 4044 patients, 655 (16 %) experienced a severe outcome, defined as ICU admission (n = 429, 11 %) or in-hospital mortality (n = 327, 8 %). SOFA (AUC 0.75 [95 %CI:0.73–0.77]) and LODS (AUC 0.73 [95 %CI:0.71–0.75]) showed the highest predictive accuracy. NEWS ≥ 5 yielded fair sensitivity (78 %) but low specificity (40 %), whereas NEWS ≥ 7 (sensitivity 71 %, specificity 59 %) performed similarly to SOFA ≥ 2 (69 %, 68 %) and LODS ≥ 2 (70 %, 66 %). In contrast, qSOFA (AUC 0.66 [95 %CI:0.64–0.69]) and SIRS (AUC 0.54 [95 %CI:0.52–0.57]) performed poorly for ED risk stratification. Interpretation: SOFA and LODS showed the highest accuracy but are limited by their complexity and the requirement for laboratory data. The NEWS score, simpler and more accessible, is a practical tool for rapid ED screening with comparable accuracy as SOFA and LODS.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Early warning score, Emergency department, Infections, Mortality
in
Journal of Infection and Public Health
volume
19
issue
4
article number
103170
publisher
Elsevier
external identifiers
  • pmid:41702364
  • scopus:105032158143
ISSN
1876-0341
DOI
10.1016/j.jiph.2026.103170
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
id
7ba1afb2-19d1-4d2b-ae3c-7d248f321d53
date added to LUP
2026-05-19 13:59:59
date last changed
2026-09-10 04:56:20
@article{7ba1afb2-19d1-4d2b-ae3c-7d248f321d53,
  abstract     = {{<p>Background: Early identification of patients with suspected infection who are at risk of clinical deterioration in the Emergency Department (ED) is challenging, yet crucial for timely initiation of appropriate care and prevention of clinical deterioration. This multicenter international study evaluates the performance of established scores (SIRS, LODS, qSOFA, SOFA, NEWS) in predicting severe outcomes in ED patients with suspected infection. Methods: We combined data from five different ED cohort studies (n = 4044 adult patients) from the Netherlands and Sweden. Suspected infection was defined as obtaining a microbiological culture combined with starting antibiotics. The scores were evaluated for their accuracy in predicting the composite outcome of intensive care unit (ICU) admission and in-hospital mortality. Findings: Of 4044 patients, 655 (16 %) experienced a severe outcome, defined as ICU admission (n = 429, 11 %) or in-hospital mortality (n = 327, 8 %). SOFA (AUC 0.75 [95 %CI:0.73–0.77]) and LODS (AUC 0.73 [95 %CI:0.71–0.75]) showed the highest predictive accuracy. NEWS ≥ 5 yielded fair sensitivity (78 %) but low specificity (40 %), whereas NEWS ≥ 7 (sensitivity 71 %, specificity 59 %) performed similarly to SOFA ≥ 2 (69 %, 68 %) and LODS ≥ 2 (70 %, 66 %). In contrast, qSOFA (AUC 0.66 [95 %CI:0.64–0.69]) and SIRS (AUC 0.54 [95 %CI:0.52–0.57]) performed poorly for ED risk stratification. Interpretation: SOFA and LODS showed the highest accuracy but are limited by their complexity and the requirement for laboratory data. The NEWS score, simpler and more accessible, is a practical tool for rapid ED screening with comparable accuracy as SOFA and LODS.</p>}},
  author       = {{Hincapié-Osorno, Carolina and van der Aart, Tamar J. and van Wijk, Raymond J. and Föhse, Konstantin and Hoogerwerf, Jacobien J. and Jaimes, Fabián and Koeze, Jacqueline and Linder, Adam and van Londen, Marco and ter Maaten, Jan C. and Mellhammar, Lisa and Tuinte, Renée A.M. and ten Oever, Jaap and Vallejo, Carlos E. and Postma, Douwe F. and Bouma, Hjalmar R.}},
  issn         = {{1876-0341}},
  keywords     = {{Early warning score; Emergency department; Infections; Mortality}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{4}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Infection and Public Health}},
  title        = {{Early risk assessment of severe outcomes in patients with suspected infection in the emergency department using clinical scores in a multicenter international validation}},
  url          = {{http://dx.doi.org/10.1016/j.jiph.2026.103170}},
  doi          = {{10.1016/j.jiph.2026.103170}},
  volume       = {{19}},
  year         = {{2026}},
}