Validity of a digital sepsis screening system combining the Manchester Triage System and a SIRS-based system for the detection of sepsis at triage in the emergency department

Abstract

Abstract Background and importanceDetection of sepsis in the emergency department (ED) should be done preferably during triage of the patients. The Manchester triage system (MTS) can be used to screen for sepsis. Objective To investigate the accuracy and validity of the MTS for detection of sepsis during triage in the ED and a combination of the MTS with a SIRS based digital sepsis screening system.DesignSingle center retrospective studySettings and participantsPatients presenting to an ED of a tertiary-care centre who received formal triage were included. (n=29766 patients). Outcome measures and analysisCalculated performance measures included sensitivity, specificity, likelihood ratios and AUC for detection of sepsis. Main resultsA total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 45 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5). Combining the MTS and the SIRS-based screening tool showed an improved sensitivity of 64.0% (95% CI 56.7 to 70.9) and a specificity of 96.8% (95% CI 96.4 to 96.8).