The Utility of Early Warning Score in Adults Presenting With Sepsis in the Emergency Department of a Low Resource Setting

Background Sepsis is a condition with high mortality and morbidity. Delay in early recognition and prompt management results in higher mortality. There are many clinical scores to identify early sepsis; however, Early Warning Score (EWS) has clinical/physiological parameters that are easy to apply in the ED for timely diagnosis and management. In the present study, we collected information regarding the utilization of EWS in timely identifying the sick patients at triage of a tertiary care center. Methods This study was a descriptive cross-sectional investigation conducted in the ED of Aga Khan University Hospital in Karachi, the largest metropolitan city in Pakistan. A total of 240 participants were selected by non-probability convenient sampling after fulfilling the inclusion criteria. Data collected included EWS criteria, demography, length of hospital stay, patient disposition (ward, intensive care or high dependency area), and differentials like sepsis, severe sepsis or septic shock. Results A total of 240 patients were enrolled, out of which 139 (57.9%) patients were male, and 101 (42.1%) were female with a mean age of 52.7 ± 15.3 years (range: 18 to 80 years). In this study, the length of stay (LOS) was 2.2 ± 1.1 (range: one to six days), and there was an EWS of 8.2 ± 2.6 (4-15). There were 143 patients in the elderly age group > 50 years (59.6%); however, most elderly presented with sepsis among both age groups. The least affected age group was aged 16 to 30 years, with 23 (9.6%) cases. An EWS >7 is best to detect cases with sepsis or severe sepsis with a sensitivity of 98.5% (95% CI: 92.13 to 99.92) and specificity of 89.57% (95% CI: 82.64 to 93.93). Similarly, the EWS for severe sepsis or septic shock was >9 with a sensitivity of 86.76% (95% CI: 76.72 to 92.88) and specificity of 88.24% (95% CI: 78.47 to 93.92). Conclusions This study revealed that the sensitivity and specificity of EWS for the detection of sepsis, severe sepsis and septic shock was found to be high; hence, it could be a valuable and readily useable system for early diagnosis and proper management of sepsis, severe sepsis, and septic shock.