Objective
We sought to design an emergency department sepsis scoring system to identify risk
of intensive care unit (ICU) admission in pregnant and postpartum women.
Study Design
The Sepsis in Obstetrics Score (S.O.S.) was created by modifying validated scoring
systems in accordance with recognized physiologic changes of pregnancy. The S.O.S.
was applied to a retrospective cohort of pregnant and postpartum patients from February
2009 through May 2011 with clinical suspicion of sepsis. The primary outcome was ICU
admission. Secondary outcomes were telemetry unit admission, length of stay, positive
blood cultures, positive influenza swabs, perinatal outcome, and maternal mortality.
Receiver operating characteristic curves were constructed to estimate the optimal
score for identification of risk of ICU admission.
Results
In all, 850 eligible women were included. There were 9 ICU (1.1%) and 32 telemetry
(3.8%) admissions, and no maternal deaths. The S.O.S. had an area under the curve
of 0.97 for ICU admission. An S.O.S. ≥6 (maximum score 28) had an area under the curve
of 0.92 with sensitivity of 88.9%, specificity of 95.2%, positive predictive value
of 16.7%, and negative predictive value of 99.9% for ICU admission, with an adjusted
odds ratio of 109 (95% confidence interval, 18–661). An S.O.S. ≥6 was independently
associated with increased ICU or telemetry unit admissions, positive blood cultures,
and fetal tachycardia.
Conclusion
A sepsis scoring system designed specifically for an obstetric population appears
to reliably identify patients at high risk for admission to the ICU. Prospective validation
is warranted.
Key words
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Article info
Publication history
Published online: March 11, 2014
Accepted:
March 5,
2014
Received in revised form:
February 22,
2014
Received:
December 31,
2013
Footnotes
The authors report no conflict of interest.
Cite this article as: Albright CM, Ali TN, Lopes V, et al. The Sepsis in Obstetrics Score: a model to identify risk of morbidity from sepsis in pregnancy. Am J Obstet Gynecol 2014;211:39.e1-8.
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
