Importance of uniform data collection and reporting in research: A call for a minimum dataset in sepsis

In 2016, the definition of sepsis was revised. Sepsis-3 defines sepsis as an increase of 2 points in the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score, which has replaced the Systemic Inflammatory Response Syndrome (SIRS). Furthermore, the qSOFA (range 0–3 points) was introduced as a bedside prompt to identify patients with suspected sepsis at risk of poorer outcomes. Both SIRS and qSOFA have imperfect test characteristics, with the former being more sensitive and the latter more specific for recognition and prognosis of sepsis. Macdonald et al. outline these historical developments and the concepts of sepsis definition and recognition in more detail in the first part of the sepsis mini-series in this issue of Emergency Medicine Australasia. Both high sensitivity (identifying who can safely be discharged) and high specificity (identifying who is at risk of a poorer outcome; death or prolonged ICU stay) are important when screening for sepsis in the ED. Therefore, the search for (more) accurate screening and prognostic tools in sepsis is ongoing. In this issue of Emergency Medicine Australasia, Shetty et al. report on test characteristics and performance of their proposed LqSOFA score. In this score, lactate measurement, with a pre-specified cut-off value (2 mmol/L), is added to the qSOFA score, effectively creating a score from 0 to 4. The authors explain that although lactate was not a component of the qSOFA model proposed by the Sepsis-3 group, it has been shown to be associated with poorer outcomes in sepsis. This makes it a logical marker of choice to investigate further in a different dataset. Shetty et al. conclude that LqSOFA is more accurate than qSOFA alone based on a higher Area Under the Receiver Operator Curve. LqSOFA had a greater sensitivity than qSOFA but a lower specificity, yet still yielding a net higher accuracy. However, the overall accuracy is still imperfect, and how the LqSOFA is to be applied in clinical practice might depend on the chosen lactate cut-off value and whether the focus is ruling in or ruling out disease. Regardless of the results and the interpretation, the authors should be commended for an impressive collaborative interstate and international effort collating and analysing data from six disparate sepsis databases. Although these databases had significant variation in recruitment procedures and data collection detail, they all included patients recruited from the ED. This is relevant as the vast majority of patients diagnosed with sepsis in hospital are admitted via the ED. In the literature, emphasis is often placed on the sickest subgroup; however, many patients never require (or might not be appropriate for) intensive care. Shetty et al. implicitly suggest that sepsis is a key issue for emergency medicine, and their paper is a reflection of this ownership. Their collaboration should provide a platform for ongoing emergency medicinedriven sepsis research and leadership. A second issue that features more explicitly in their discussion, and exposes a clear unmet need, is the call for a minimum dataset (MDS) for sepsis in the ED. They recognise that variation in definitions and data collection made the merger of the separate datasets in their study a colossal and complex task. This is highlighted by the absence of Glasgow Coma Scale (GCS – one of qSOFA variables) information for one of the larger datasets. Not part of the intended primary analysis for that particular dataset, data for GCS were not collected, leading the authors to resort to (statistical) assumptions. Although that approach is fair, such a methodological weakness would not have occurred if an accepted MDS had been in existence.