Quick sequential organ failure assessment: big databases vs. intelligent doctors

In everyday clinical practice, sepsis has always been considered as a “bad infection” accompanied by some form of associated organ dysfunction (1). In recent years, the importance of identifying sepsis early so that it can be treated promptly has increasingly been highlighted. In this context, we need to look for variables that could be used as early indicators of sepsis on the regular floor, before a patient becomes ill enough to require intensive care. The big question to consider when determining the value of such “indicators” is, “what is their sensitivity?”. If the sensitivity is too low, some patients may be missed, but if too high, too many patients may be “flagged” as possibly having sepsis, making practical implementation impossible. In particular, targeting “infection” is inappropriate, because only a minority of patients with infection will become septic and some septic patients may not have an obvious infection (2).