Comparison of the Prognostic Accuracy of Sepsis Scoring Systems: A Prospective Study in Patients with Suspected Infection in the Emergency Department

Background/Objectives: Sepsis is a life-threatening organ dysfunction and a leading cause of mortality due to infection worldwide. Early recognition and rapid intervention in Emergency Department (ED) are critical, therefore diagnostic/prognostic tools are used to guide and prioritize interventions. This study compared the prognostic accuracy of four sepsis scoring systems; Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), National Early Warning Score 2 (NEWS2), and quick Sequential Organ Failure Assessment (qSOFA). Methods: A prospective observational study was conducted at a general hospital in Athens, Greece. The study population included adult patients (≥18 years) presenting to the ED with suspected infection. To support data collection, a custom-designed patient registration form was developed. The study was conducted in the ED triage from December 1, 2023, to December 1, 2024. The outcomes assessed included 28-day in-hospital mortality and Intensive Care Unit (ICU) stay of ≥ 3 days. Results: For 28-day in-hospital mortality, qSOFA showed the highest overall accuracy (84.91%) and Area Under the Receiver Operating Characteristic curve (AUROC; 0.7895), followed by NEWS2 (AUROC; 0.7712) both significantly outperformed SIRS and MEWS. For ICU stay ≥3 days, qSOFA showed the highest overall accuracy (81.04%) and NEWS2 the best AUROC (0.7248) while SIRS had significantly lower discriminatory ability of the four scales. Conclusions: This study evaluated qSOFA, NEWS2, SIRS, and MEWS scales for predicting 28-day in-hospital mortality and prolonged ICU stays in ED patients with suspected sepsis. qSOFA and NEWS2 showed superior predictive accuracy, significantly outperforming SIRS and MEWS. qSOFA’s simplicity makes it ideal for rapid triage, while NEWS2 suits continuous monitoring.