New sepsis scoring system aids in predicting morbidity in obstetric patients

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1. Patients with a Sepsis in Obstetrics Score (SOS) ≥6 were more likely to be admitted to the ICU. 

2. The SOS predicted risk of severe sepsis-related morbidity more accurately than other existing ED sepsis scoring systems.   

Evidence Rating Level: 2 (Good)

Study Rundown: This study found that the SOS, a scoring system that combines and adapts parts of the Rapid Emergency Medicine Score (REMS) and SIRS criteria, was a good predictor of ICU admission in pregnant and postpartum women. Past work has focused on developing sepsis scoring systems in the general population; these scales typically overestimate the risk of morbidity and mortality in obstetric patients. The present work provides a new scoring system that more accurately identifies risk of sepsis-related morbidity in the obstetric population.

Limitations include retrospective design and low rate of morbidity and mortality. Additionally, use of ICU admission as the primary outcome may affect the sensitivity and specificity of the score, as different providers may have different thresholds for recommending admission. Multicenter prospective studies are needed to further validate the use of the SOS to predict sepsis-related morbidity and mortality in pregnant and postpartum women.

Click to read the study in AJOG

Relevant Reading: Evaluation of standard and modified severity of illness scores in the obstetric patient

Study Author, Dr. Catherine Albright, MD, talks to 2 Minute Medicine: Warren Alpert Medical School at Brown University, Women and Infants Hospital, Department of Obstetrics and Gynecology, Maternal Fetal Medicine Fellow

“Those who routinely work with pregnant women know that it can be very hard to identify sepsis in its early stages because of the normal physiologic changes of pregnancy, which in turn means that they may not be receiving the appropriate goal-directed therapy. This research brings to light that we can’t rely on scoring systems that were not developed for pregnant women to aid in diagnosing them and that specific scoring is needed. Once we can appropriately diagnose obstetric patients, we can better treat them.”

In-Depth [retrospective cohort study]: This study evaluated the ability of the newly developed SOS to predict morbidity in 850 pregnant and postpartum women presenting at the ED with signs or symptoms of sepsis. Outcomes evaluated include ICU admission, telemetry unit admission, length of hospital stay, positive blood cultures or influenza swabs, antibiotic use and adverse perinatal events.

Patients with SOS≥6 were more likely to be admitted to the ICU or a telemetry unit (p<0.0001), have positive blood cultures (p<0.0003), fetal tachycardia (p<0.0001) and longer hospital stays (p<0.0004). Using a cutoff of 6, the SOS demonstrated superior sensitivity, specificity, positive predictive value and negative predictive value when compared to the REMS and the Modified Early Warning Score.

More from this author: Induction after 40 weeks in women with gestational diabetes associated with Cesarean delivery, Potential overuse of routine postpartum CBC, Poor fetal growth in overweight & obese with insufficient weight gain, Elective induction may increase risk of C-section in obese women, New method of cervicovaginal reconstruction piloted 

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