AzTrials
AzTrials

SepsisPASSEMNCT05172479

Prognostic Accuracy of qSOFA, SIRS, and EWSs for In-hospital Mortality in Emergency Department

An observational study of Sepsis and Septic Shock, run by Aseer Central Hospital at 20 sites in 7 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Sepsis, Septic Shock
What is being tested?
Measurement of qSOFA score, Measurement of SIRS criteria and Measurement of NEWS
How many people
3,274 participants
Where
20 sitesin 7 countries
Study dates
12 Dec 2021to 11 Sep 2023
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: All consecutive adult patients (age ≥18 years) presenting to the ED with suspected infection who planned to be hospitalized and willing to give informed consent (if required by recruiting center IRB) are eligible. A presumptive diagnosis of infection will be judged based on the opinion of the emergency physician upon the initial patient presentation to the ED. We will exclude patients with evidence of other causes of presentation to the ED other than infection (e.g., autoimmune diseases, myocardial infarction, trauma, …etc.), pregnant ladies, those who transferred from other hospitals, those not planned for hospitalization, or those who admitted electively to the hospital through ED. We will also exclude patients whose initial diagnosis of infection in the ED was not confirmed after the recruitment and follow-up.

Who may be able to join

  • Adult patients (age ≥18 years),
  • Suspected infection (based on the opinion of the emergency physician),
  • Planned for hospitalization,
  • Willing to give oral informed consent (if required by recruiting center's IRB).

Who cannot join

  • Presentation to ED is not due to infection (e.g., autoimmune diseases, myocardial infarction, stroke, venous thromboembolism, trauma, intoxication … etc.),
  • Pregnancy,
  • Transferred from another hospitals,
  • Code status is "Do-Not-Resuscitate" (DNR)
  • Elective admission through ED
  • Initial diagnosis of infection in the ED was not confirmed after finishing of the recruitment and follow-up phase.

Trial locations and contacts

20 sites in 7 countries.

20 sites in 7 countries

Saudi Arabia12 sites
  • Aseer Central Hospital (ACH)

    Abhā, Aseer Province, 62523

  • North Medical Tower

    Arar, Northern Borders Province, 73241

  • King Fahad Specialist Hospital

    Dammam, Eastern Province, 32253

  • Johns Hopkins Aramco Healthcare

    Dhahran, Eastern Province, 34465

  • King Abdulaziz University Hospital

    Jeddah, Makkah Al Mukarramah Province, 22252

  • King Fahd Armed Forces Hospital

    Jeddah, Makkah Al Mukarramah Province, 23311

  • Royal Commission Hospital in Jubail

    Jubail, Eastern Province, 31961

  • Armed Force Hospital Southern Region-Khamis Mushayt (AFHSR-KM)

    Khamis Mushait, Aseer Province, 62413

  • King Abdullah bin Abdulaziz University Hospital (KAAUH)

    Riyadh, Riyadh Region, 11564

  • King Fahad Medical City (KFMC)

    Riyadh, Riyadh Region, 12231

  • King Saud Medical City (KSMC)

    Riyadh, Riyadh Region, 12746

  • Sulaiman Al-Habib Hospital

    Riyadh

Other trials in Saudi Arabia

Bahrain2 sites
  • King Hamad University Hospital

    Al Muharraq

  • Bahrain Defence Force Hospital

    Riffa, Southern Governorate, 947

Other trials in Bahrain

United Arab Emirates2 sites
  • Sheikh Shakhbout Medical City

    Abu Dhabi

  • Rashid Hospital

    Dubai

Other trials in United Arab Emirates

Kuwait1 site
  • Amiri Hospital

    Kuwait City

Other trials in Kuwait

Oman1 site
  • Armed Forces Hospital Oman

    Muscat, 111

Other trials in Oman

Qatar1 site
  • Hamad Medical Corporation

    Doha

Other trials in Qatar

Turkey (Türkiye)1 site
  • Kocaeli University Hospital

    Kocaeli, 41380

Other trials in Turkey (Türkiye)

About this study

Official title: Prognostic Accuracy of qSOFA Score, SIRS Criteria, and EWSs for In-hospital Mortality Among Adult Patients Presenting With Suspected Infection to the Emergency Department (PASSEM): Protocol for an International Multicentre Prospective External Validation Cohort Study

Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). The 2016 SCCM/ESICM task force recommended using qSOFA, while the 2021 Surviving Sepsis Campaign strongly recommended against its use compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock. We hypothesised that qSOFA has greater prognostic accuracy than SIRS and EWS (NEWS/NEWS2/MEWS).

Read the detailed description

Over the past decade, medical advances in sepsis continued to focus on sepsis as a prevalent condition that accounts for 10% of admissions to intensive care units (ICUs) and is associated with a 10-20% in-hospital mortality rate. Standardised protocols and physician awareness have significantly improved survival, but mortality rates remain between 20% and 36%, with ~270,000 deaths annually in the United States. However, of patients with sepsis, 80% are treated in an emergency department (ED), and the remainder develops sepsis during hospitalisation with other conditions. In 2016, the Society of Critical Care Medicine/European Society of Intensive Care Medicine (SCCM/ESICM) task force redefined sepsis based on organ dysfunction and mortality prediction. Sepsis now is defined as life-threatening organ dysfunction caused by dysregulated host response to infection. This definition emphasises the complexity of the disease that cannot be explained by infection or body response to it. Acute change in Sequential Organ Failure Assessment (SOFA) score ≥2 indicates sepsis-related organ dysfunction, a predictor of excess in-hospital mortality. Systemic Inflammatory Response Syndrome (SIRS) and "severe sepsis" terms were omitted from the most recent definition. SIRS has been criticised for its poor specificity, while "severe sepsis" may underestimate sepsis's seriousness. A subset of patients may develop septic shock with underlying profound organ dysfunction and excess mortality. Clinically, septic shock is defined as persistent hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥ 65 mm Hg and serum lactate level ≥ 2 mmol/L (18 mg/dL) despite adequate volume resuscitation. Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). The 2016 SCCM/ESICM task force recommended using qSOFA, while the 2021 Surviving Sepsis Campaign strongly recommended against its use compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock. We hypothesised that qSOFA has greater prognostic accuracy than SIRS and EWS (NEWS/NEWS2/MEWS).

Conditions
Sepsis, Septic Shock
Being tested
Measurement of qSOFA score, Measurement of SIRS criteria, Measurement of NEWS, Measurement of NEWS2, Measurement of MEWS
Keywords
Sepsis, Septic shock, qSOFA, SIRS, EWS, NEWS, NEWS2, MEWS, Emergency department
Medical subject headings
Sepsis, Shock, Septic, Emergencies

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Measurement of qSOFA scoreDiagnostic test

    Also called quick Sequential Organ Failure Assessment (qSOFA)

    At the patient's arrival to the ED triage, the nurse will enter the patient's vital signs data into electronic data capture (EDC) system that will calculate the patient's qSOFA score.

  • Measurement of SIRS criteriaDiagnostic test

    Also called Systemic inflammatory response syndrome (SIRS)

    At the patient's arrival to the ED triage, the nurse will enter the patient's vital signs data into electronic data capture (EDC) system that will calculate the patient's SIRS criteria.

  • Measurement of NEWSDiagnostic test

    Also called National Early Warning Score (NEWS)

    At the patient's arrival to the ED triage, the nurse will enter the patient's vital signs data into electronic data capture (EDC) system that will calculate the patient's NEWS.

  • Measurement of NEWS2Diagnostic test

    Also called National Early Warning Score 2 (NEWS2)

    At the patient's arrival to the ED triage, the nurse will enter the patient's vital signs data into electronic data capture (EDC) system that will calculate the patient's NEWS2.

  • Measurement of MEWSDiagnostic test

    Also called Modified Early Warning Score (MEWS)

    At the patient's arrival to the ED triage, the nurse will enter the patient's vital signs data into electronic data capture (EDC) system that will calculate the patient's MEWS.

Study groups in NCT05172479
Study groupRoleWhat they receive
Positive qSOFAAdult patients with suspected infection and a qSOFA score ≥ 2 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of qSOFA score
Negative qSOFAAdult patients with suspected infection and a qSOFA score < 2 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of qSOFA score
Positive SIRSAdult patients with suspected infection and a SIRS criteria ≥ 2 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of SIRS criteria
Negative SIRSAdult patients with suspected infection and a SIRS criteria < 2 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of SIRS criteria
Positive NEWSAdult patients with suspected infection and a NEWS ≥ 5 or red score (i.e., a score of 3 in any one parameter) at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of NEWS
Negative NEWSAdult patients with suspected infection and a NEWS < 5 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of NEWS
Positive NEWS2Adult patients with suspected infection and a NEWS2 ≥ 5 or red score (i.e., a score of 3 in any one parameter) at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of NEWS2
Negative NEWS2Adult patients with suspected infection and a NEWS2 < 5 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of NEWS2
Positive MEWSAdult patients with suspected infection and a MEWS ≥ 5 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of MEWS
Negative MEWSAdult patients with suspected infection and a MEWS < 5 at the triage in the ED who are planned for hospitalization
Receives: Diagnostic Test: Measurement of MEWS

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. In-hospital mortality

    Mortality rate during hospitalization of patient

    Measured: 30 days

Secondary outcomes (2)
  1. Intensive care unit admission

    Number of participants admitted to an intensive care unit

    Measured: 30 days

  2. Length of stay in the intensive care unit

    Stay in intensive care unit >72 hours

    Measured: 30 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Dec 2021
  2. Study start12 Dec 2021
  3. Primary completion11 Sep 2023
  4. Study completion11 Sep 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
3,274 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05172479
Sponsor's protocol ID
ACH-2
Acronym
PASSEM
Status last verified
Sep 2023
First submitted
3 Dec 2021
Last updated
13 Sep 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Algarni AM, Alfaifi MS, Al Bshabshe AA, Omair OM, Alsultan MA, Alzahrani HM, Alali HE, Alsabaani AA, Alqarni AM, Alghanem SA, Al Mufareh BS, Almemari AM, Sindi AA, Ozturan IU, Alhadhira AA, Shujaa AS, Alotaibi AH, Awladthani MM, Alsaad AA, Almarshed AA, AlQahtani AM, Harris TR, Alyahya BA, Assiri SA, Abuzeyad FH, Kazim SN, Al-Fares AA, Almazroua FY, Marzook NT, Basri AA, Elsafti AM, Alalshaikh AS, Ozturan CA, Alawad YI, AlOmari A, Alkhateeb MA, Farooq MM, AlMutairi LA, Alasfour MM, Al Haber MI, Umar UA, Bokhary NH, Alqahtani SF, Almutairi A, Alyahya HF, Alzahrani WS, Alsalmi F, Omair AM, Alasmari FM, Alfifi SY, Al-Nujimi MS, Foroutan F. Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol. PLoS One. 2024 Jan 17;19(1):e0281208. doi: 10.1371/journal.pone.0281208. eCollection 2024.

    PubMed 38232095

Questions about this trial

What is this clinical trial studying?

An observational study of Sepsis and Septic Shock, run by Aseer Central Hospital at 20 sites in 7 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Sep 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 20 sites in Saudi Arabia, Bahrain, United Arab Emirates, Kuwait, Oman and 2 more countries. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

In-hospital mortality (time frame: 30 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05172479, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Sep 2023.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in