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Master Thesis

Comparaison des indicateurs de performance (sensibilité et spécificité) des scores qSOFA, SIRS, NEWS et RETTS pour le diagnostic du patient infecté dès l’accueil des urgences

Abstract : Introduction : The last international recommendations of February 2016 have defined again the septic pathology, giving up on the SIRS criterias and leaving vacant the definition of the infection. Different tools of sorting method have been described in the literature to target patients who presented risks of bad evolution. Those scores have been the subject of several publications in these last 10 years but always regarding their ability to predict the mortability or the hospitalisation in the service of intensive care of the septic patients. However, very few studies have been comparing the performance index of those scores to diagnose the patient ‘infected’. Goal : Evaluate the diagnostic performance index (Sensibillity and specificity) of those scores qSOFA, SIRS, NEWS and RETTS and determine which one of these holds the best relation sensitivity/specificity for the detection of the infected patient in emergency.
Support & Methods : We’ve led a study on an observational potential group, multi-centric at the front desk of the emergency of 4 public hospital centres in the area of Provence-Alpes Cotes d’Azur between the 9th and the 13rd of April 2018. Have been excluded, all patients above 18 years old, no matter what was their reason for consultation and outside any isolated traumas. We’ve been comparing the performance index (sensibility and specificity) of those 4 scores relative to the infection, the sepsis and the mortality at day the 28th. Results : We’ve been including 753 patients within which 125 were infected and 31 septic. The mortality at the 28th day was statistically superior within the patient infected (6,4%) compared to the non infected ones (1,6%), with a p=0,0044. The scores SIRS and RETTS were similar in terms of sensibility (37,6% versus 39,2) with a p=0,8746. They were more sensitive to the NEWS score (22,4%) with a p respectively equal to 0.0002 and 0.0005. The NEWS score itself had a sensitivity superior at the qSOFA score (7,2%) with a p<0,0001. The score qSOFA had an excellent specificity of 98.6% IC95%[97,3-99,2] . It was statistically superior at the NEWS score (96.5%), (p=0.0106) that was itself superior at the SIRS (88.2%) and at the RETTS (79.1%), (p<0.0001).
Conclusion: The qSOFA, SIRS, NEWS and RETTS have not shown any suffisant combined performance index to diagnose by themselves the infected patients from their admission to the emergency. However, the score NEWS appears to be better than the qSOFA and as performant as the SIRS by avoiding the little specificity of this one. The RETTS though has an interesting sensibility but at the price of a bad specificity
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Master Thesis
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Kevin Durand. Comparaison des indicateurs de performance (sensibilité et spécificité) des scores qSOFA, SIRS, NEWS et RETTS pour le diagnostic du patient infecté dès l’accueil des urgences. Médecine humaine et pathologie. 2019. ⟨dumas-02389769⟩

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