BACKGROUND: Sepsis progresses rapidly and is associated with considerable morbidity and mortality. Bedside risk stratification scores can quickly identify patients at greatest risk of poor outcomes; however, there is lack of consensus on the best scale to use.

OBJECTIVE: To compare the ability of quick Sequential Organ Failure Assessment (qSOFA), the National Early Warning System (NEWS2), and the Shock Index—which does not require mental status assessment—to predict poor outcomes among patients with suspected sepsis during triage.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adults presenting to an academic emergency department (ED) from June 2012 to December 2018 who had blood cultures and intravenous antibiotics within 24 hours.

MAIN OUTCOMES AND MEASURES: Clinical data were collected from the electronic health record. Patients were considered positive at qSOFA ≥2, Shock Index >0.7, or NEWS2 ≥5 scores. We calculated test characteristics and area under the receiver operating characteristics curves (AUROCs) to predict in-hospital mortality and ED-to-intensive care unit (ICU) admission.

RESULTS: We included 23,837 ED patients; 1,921(8.1%) were qSOFA-positive, 4,273 (17.9%) Shock Index-positive, and 11,832 (49.6%) NEWS2-positive. There were 1,427 (6.0%) deaths and 3,149 (13.2%) ED-to-ICU admissions in the sample. NEWS2 had the highest sensitivity for in-hospital mortality (76.0%) and ED-to-ICU admission (78.9%). qSOFA had the highest specificity for in-hospital mortality (93.4%) and ED-to-ICU admission (95.2%). Shock Index exhibited the highest AUROC for in-hospital mortality (0.648; 95 CI, 0.635-0.662) and ED-to-ICU admission (0.680; 95% CI, 0.617-0.689). Test characteristics were similar among those with sepsis.

CONCLUSIONS: Institution priorities should drive score selection, balancing sensitivity and specificity. In our study, qSOFA was highly specific and NEWS2 was the most sensitive for ruling out patients at high risk. Performance of the Shock Index fell between qSOFA and NEWS2 and could be considered because it is easy to implement. Journal of Hospital Medicine 2021;16:XXX-XXX. © 2021 Society of Hospital Medicine

背景：脓毒症进展迅速，并且与相当大的发病率和死亡率相关。床边风险分层评分可以快速识别出预后不良风险最大的患者；但是，对于使用的最佳规模缺乏共识。

目的：比较快速序贯器官衰竭评估 (qSOFA)、国家早期预警系统 (NEWS2) 和休克指数（不需要进行精神状态评估）预测疑似脓毒症患者分诊期间预后不良的能力。

设计、地点和参与者：对 2012 年 6 月至 2018 年 12 月在学术急诊科 (ED) 就诊的成人进行回顾性队列研究，他们在 24 小时内进行了血培养和静脉注射抗生素。

主要结果和措施：从电子健康记录中收集临床数据。在 qSOFA ≥2、休克指数 >0.7 或 NEWS2 ≥5 评分时，患者被认为是阳性的。我们计算了受试者工作特征曲线 (AUROC) 下的测试特征和面积，以预测住院死亡率和 ED 到重症监护室 (ICU) 的入院情况。

结果：我们纳入了 23,837 名 ED 患者；1,921 (8.1%) 是 qSOFA 阳性，4,273 (17.9%) 冲击指数阳性和 11,832 (49.6%) NEWS2 阳性。样本中有 1,427 人（6.0%）死亡和 3,149 人（13.2%）从 ED 到 ICU 入院。NEWS2 对住院死亡率 (76.0%) 和 ED 到 ICU 入院 (78.9%) 的敏感性最高。qSOFA 对住院死亡率 (93.4%) 和 ED 到 ICU 入院 (95.2%) 的特异性最高。休克指数在住院死亡率（0.648；95 CI，0.635-0.662）和 ED 到 ICU 入院（0.680；95% CI，0.617-0.689）方面表现出最高的 AUROC。脓毒症患者的测试特征相似。

结论：机构优先事项应推动分数选择，平衡敏感性和特异性。在我们的研究中，qSOFA 具有高度特异性，NEWS2 对排除高危患者最敏感。Shock Index 的表现介于 qSOFA 和 NEWS2 之间，可以考虑，因为它易于实施。医院医学杂志2021；16:XXX-XXX。© 2021 医院医学会