THE REDS SCORE A NEW SCORING TO RISK STRATIFY EMERGENCY DEPARTMENT SUSPECTED SEPSIS
Authors: Balakrishnan Niveditha , Mehta Manish , Jain Sandeep , Juneja Deven 
Published: July 2023

To risk stratify ED suspected sepsis (REDS) patients who require admission into low risk and high risk and analyzing inhospital mortality of patients stratied as high risk by REDS score and the performance of REDS score will be compared
with widely used qSOFA score prospective observational study Emergency departme Design – Setting – Participant – nt Patients aged ≥18
years who met two Systemic Inammatory Response Syndrome criteria or one Red Flag sepsis criteria on arrival, received intravenous
antibiotics for a suspected infection and admitted. in-hospital all cause m Primary outcome measure – Method – ortality based on REDS score
The sample size calculation has been done based on the information provided in the article by Sivayoham et al., In the original BMJ article, it is
mentioned that "The AUROC curve of the REDS score 0.78 (95%CI 0.75 to 0.80) was similar to that of the regression model, negating the need
to weight the component scores." The following formula has been used for the calculation of the sample size:
where, z1-α/2 = 1.96 for 95% level of condence L = 0.05, error in the estimate of AUC on both sides AUC = 0.78, anticipated area under the
curve
After all the calculations, the sample size comes to a minimum of 195 cases with the disease. The REDS score had a better AUROC Result –
curve for mortality in the high-risk category than its component Q-Sofa scores. Score ≥ 7 associated with high mortality and denitely needs ICU
admission. Risk stratication by REDS score might have decreased ICU admission for logistics reasons as compared to Physicians decision of
admission based on clinical judgement The REDS score is a simple and Conclusion – objective scoring system that uses widely available
variables to risk-stratify ED patients suspected of having sepsis and is better than its component scores.
Strengths
There are several strengths to our study
1. The broad inclusion criteria allowed the inclusion of a wide variety of patients withsuspected sepsis
2. Very few scoring studies has been conducted in emergency department , most of the scoring studies like SOFA, q-SOFA,s-MISSED were
validation studies from ICU
3. Most of scoring studies were prognostication studies & mortality scoring studies , but our study is risk stratication study
4. This is one of few risks stratication scoring system study in India and the rst study to be conducted in ED department apart from PIRO
study (AIIMS-Delhi)
5. We had reasonably larger number of patients (n=196)
6. It is a prospective study
Limitations
There are several limitations to our study
1. The population studied is conned to max super specialty hospital, Delhi. It is a single- center study and requires external validation.
2. Limiting the outcome to in-hospital mortality may have resulted in the underestimation of mortality as patients discharged before 28 days but
died within 28 days would not have been recognized.
3. Over 54.1% of patient were admitted in ICU as per physicians' decision while the REDS score suggesting 35.2% admissions in ICU The
reason physician's decision for ICU admission were not studied. Some ICU admissions may have occurred for logistical reasons when
stafng skill and bed availability in other areas of the hospital were limited. This may have contributed to the lower sensitivity for ICU
admissions in the high-risk group.
4. REDS score may not pick-up patients who develop organ dysfunction. We also cannot advocate discharge from the ED based on a REDS
score of 0, as the PPV / NPV for a REDS score . 0.267 0.929 for the composite endpoint of death or ICU admission. However, it is clear that
the sensitivity for mortality of the REDS score above the cut-off point is greater than the sensitivities of the component score above their
respective cut-off points for ED patients.
5. From a practical point, the calculation of the REDS score can only be completed after the initial treatment bundle (antibiotics and uid) is
complete and the results of the serum albumin and INR are available.