Response to Re: Modified Sequential Organ Failure Assessment score for predicting mortality in emergency department patients with sepsis

Dear Editor, We read with great interest the article by Vosseteig et al. The authors verified the accuracy of the modified Sequential Organ Failure Assessment (mSOFA) score for predicting 30-day mortality in ED patients with sepsis and compared it with the quick SOFA (qSOFA) score. The results show that the added complexity of the mSOFA without a significant increase in discriminative ability makes it unlikely to replace qSOFA in the ED setting. However, we have some concerns about the findings. First, according to the literature, there is little likelihood that the area under the curve (AUC) of the qSOFA score will be higher than 0.8. It is unbelievable that the qSOFA has fewer parameters and a higher AUC (0.81 vs 0.74 for mSOFA). Validation of small data sets may lead to this unreliable result. Second, discrimination (use the AUC) and calibration are two common classical statistical methods for assessing prediction models (one form of prediction model is score). The net reclassification index, integrated discrimination improvement and decision curve analysis are the previous three statistical methods that are currently frequently utilised to evaluate prediction models. However, the AUC analysis is the only method used in this paper. Third, there is clear indication that some of the variables in the SOFA score may need to be modified or updated, and the mSOFA score is still a laudable attempt, which seems more convenient for clinical practice. Finally, there is a small error in table 2, and the number of negative cases in the mSOFA score result was 11 (n = 11); however, I think it should be 211. Modifying the SOFA score should be challenging, and this process should follow the TRIPOD statement. The protocol and sample size of this article need to be improved, and its unreliable results may decrease confidence in future research in this field.

• Publication year

  2023

• Venue

  Emergency Medicine Australasia

• Publication date

  2023-03-02

• Fields of study

  Medicine

• Identifiers
  DOI 10.1111/1742-6723.14197PMID 36864678
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

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