P-922. Feasibility and Diagnostic Performance of Sepsis Scores in Supporting Early Intervention and Strengthening Antimicrobial Stewardship in Low-Resource Hospitals in LMICs

TL;DR

This study compares sepsis diagnostic tools in low-resource hospitals, finding that the NEWS2 score is accurate and practical for early detection and guiding antibiotic use.

Contribution

The study evaluates the feasibility and accuracy of sepsis scores in low-resource settings, identifying NEWS2 as a reliable alternative to lab-dependent methods.

Findings

NEWS2 showed the highest diagnostic accuracy with an AUC of 0.81 and sensitivity of 84.4%.

NEWS2 score >7 was significantly associated with blood culture positivity (p-value 0.032).

qSOFA had better sensitivity but lower specificity compared to NEWS2 and SOFA.

Abstract

Diagnosing sepsis remains difficult due to its sudden presentation and the need for immediate clinical decisions. The SSC 2021 guidelines recommend SOFA as the gold standard, but its reliance on laboratory investigations limits use in low-resource hospitals. Other scores not requiring labs raise questions about diagnostic accuracy compared to SOFA. This study compares qSOFA, NEWS2, MEWS, and SOFA to identify a feasible and accurate screening method for early sepsis detection and analyse their association with culture positive in resource-limited settings.Diagnostic accuracy and comparison of Sepsis scoresROC curve

Diagnostic accuracy and comparison of Sepsis scores

ROC curve

A six-month prospective observational study was conducted among adult patients ( >18 years) with suspected infection presenting to the Emergency Department and ICU of a tertiary care hospital. qSOFA, SOFA, NEWS2, and MEWS scores were calculated at admission. ROC curve analysis and AUC comparisons were performed to evaluate diagnostic accuracy and chi square test for association of blood culture positives.

Of 411 patients with suspected or confirmed infection, 144 with sepsis were included. Among the scores, NEWS2 showed the highest diagnostic accuracy with AUC 0.81, sensitivity 84.4% and PPV 81.2%. (fig 1) SOFA had moderate performance with AUC 0.67, while qSOFA showed better sensitivity with AUC 0.75 but lower specificity. MEWS performed the poorest with AUC 0.51. (Table 1). NEWS2 greater than 7 was significantly associated with blood culture positivity with a p-value of 0.032, supporting its use in guiding antimicrobial initiation.

This study shows that NEWS2, based solely on vital signs, can reliably identify sepsis with diagnostic accuracy comparable to more complex scores, offering a practical solution for early detection in low-resource settings. A NEWS2 score > 7 demonstrated significant association with blood culture positivity, supporting its use to guide early antibiotic initiation where laboratory support is limited. These findings represent an important step toward improving sepsis care and antibiotic stewardship in frontline environments. Further validation is needed, and NEWS2 should be considered for adoption as a standard tool for sepsis diagnosis in low-resource healthcare settings

All Authors: No reported disclosures

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