From the Guidelines
The most clinically supported scoring systems used in emergency departments include the Pulmonary Embolism Rule-out Criteria (PERC) for excluding pulmonary embolism, as well as other tools like the Wells score for DVT/PE, HEART score for chest pain, qSOFA and SIRS for sepsis identification, CURB-65 for pneumonia severity, and others. These scoring systems are essential for rapid, evidence-based decision-making in patient care, helping to standardize assessment, reduce unnecessary testing, and prioritize resources for higher-risk patients. The PERC rule, in particular, is useful for identifying patients with a low likelihood of pulmonary embolism, allowing clinicians to safely exclude diagnostic workup in these cases, as supported by studies such as 1. Key components of the PERC rule include age < 50 years, pulse < 100 beats per minute, SaO2 >94%, and other clinical variables significantly associated with an absence of PE. The Wells criteria and other scoring systems also play critical roles in determining pre-test probability of thromboembolism and identifying patients at risk of poor outcomes from infection or other conditions, as discussed in studies like 1, 1, and 1. By applying these scoring systems, clinicians can improve patient outcomes by reducing morbidity, mortality, and unnecessary resource utilization, aligning with the principles of evidence-based medicine and the latest clinical guidelines, such as those outlined in 1. Some of the other scoring systems mentioned, like the HEART score, qSOFA, and CURB-65, offer simplified bedside tools for risk stratification and decision-making in various clinical scenarios, further emphasizing the importance of these tools in emergency department settings. Overall, the use of these clinically supported scoring systems is crucial for optimizing patient care and resource allocation in emergency medicine, as highlighted by the evidence from 1.
From the Research
Clinically Supported Scoring Systems
The following scoring systems are used in the emergency department to diagnose and manage various conditions:
- Pulmonary Embolism Rule-out Criteria (PERC) 2, 3
- Systemic Inflammatory Response Syndrome (SIRS) 4, 5, 6
- Quick Sequential Organ Failure Assessment (qSOFA) score 4, 5, 6
- Modified National Early Warning Score (mNEWS) 4
- Modified Search Out Severity (mSOS) score 4
- CEC SEPSIS KILLS pathway 5
- Shapiro criteria 5
Characteristics of Scoring Systems
Some key characteristics of these scoring systems include:
- The PERC rule is designed to exclude pulmonary embolism without further testing, but its effectiveness is debated 2, 3
- SIRS criteria are commonly used to identify sepsis, but may not be as sensitive as other scoring systems 4, 5, 6
- The qSOFA score is useful for predicting mortality in septic patients, but may not be as effective as a screening tool for sepsis 6
- The mNEWS score has been shown to be effective in predicting mortality and sepsis in patients with suspected infection 4
Comparison of Scoring Systems
Studies have compared the performance of different scoring systems, including:
- A comparison of mNEWS, qSOFA, mSIRS, and mSOS scores found that mNEWS had the highest sensitivity and area under the receiver operating characteristic curve for predicting mortality and sepsis 4
- A comparison of qSOFA, SIRS, Shapiro criteria, and CEC SEPSIS KILLS pathway found that the modified Shapiro criteria had the highest sensitivity, while qSOFA had the highest specificity 5
- A comparison of qSOFA and SIRS criteria found that SIRS criteria were met more quickly and were more sensitive, but qSOFA may be more specific 6