Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

Secondary peritonitis, Adverse outcomes, qSOFA, SIRS

Background: SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of
ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda
uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes.
However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which
are often not quickly available in a resource limited emergency setting. In response to the practical limitations of
SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with
secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary
teaching hospital in a low and middle income country like Uganda.
Objective: To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary
peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda.
Methods: This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from
March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching
hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high
risk, while a score of < 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were
followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and
secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval
were calculated for each of the scores using STATA v.13
Results: A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2
were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted
in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay
with AUROC of 0.54 versus 0.57, for SIRS.
Conclusion: SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients
with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes
and therefore not ideal tools.

Emmanuel Nkonge, Olivia Kituuka, William Ocen, Herbert Ariaka, Alfred Ogwal and Badru Ssekitoleko

BMC Emergency Medicine

(2021) 21:128

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