Clinical Report: Looking Beyond Discrimination in Prehospital Scores

Overview

The article examines whether the prehospital mSOFA score misses a clinically important subgroup despite strong overall discrimination for two-day mortality. In a prospective multicenter cohort, a secondary screen combining lactate and GCS identified 73 of 85 deaths among patients with mSOFA below 5, increasing reported sensitivity from 90.9% to 98.7%.

Background

Prehospital prediction scores are commonly summarized by AUROC, but this measure does not show which patients are misclassified or whether errors are clinically acceptable. In emergency care, a false-negative classification may affect monitoring, destination decisions, and pre-arrival preparation. The mSOFA score uses five first-contact physiological or laboratory variables and was developed within the APPS multicenter clinical–academic platform in Spain. The article focuses on whether a secondary screen can identify patients with low mSOFA scores who nevertheless die within two days.

Data Highlights

Key Findings

• The mSOFA score combines mean arterial pressure, GCS, oxygenation, creatinine, and lactate; a score of 5 or higher marks high acuity in the described approach.
• A prospective multicenter validation involving more than 12,000 patients reported an AUROC of 0.944 for two-day mortality.
• In the 16,106-patient study, 85 patients died despite having mSOFA below 5.
• Among false-negative patients, lactate and GCS had a positive association (Spearman’s ρ = 0.616), with higher lactate accompanying better-preserved consciousness.
• The proposed OHI is lactate × (16 − GCS), with a derivation threshold of 3.38; at GCS 15, the index equals the lactate value.
• For patients with mSOFA below 5, the OHI identified 73 of 85 deaths and the article reports sensitivity increasing from 90.9% to 98.7% for two-day mortality.

Clinical Implications

The article proposes using OHI as a sequential secondary screen for patients with mSOFA below 5; a positive result would prompt reclassification as high risk and consideration of intensified monitoring, an appropriately equipped receiving center, and early pre-arrival notification. The supplied text reports these as proposed operational responses and does not provide the remainder of the article’s results on external validation or operational burden.

Conclusion

The source describes OHI as a secondary screen intended to address deaths missed by the mSOFA high-acuity threshold. Its reported sensitivity findings are based on the described study, while the supplied article text ends before completing its account of geographically separate validation.

Related Resources & Content

1. Martín-Rodríguez, Sanz-García, et al., Source details not provided, 2021 -- Development of the prehospital modified Sequential Organ Failure Assessment (mSOFA) score
2. mSOFA validation study, Source details not provided -- Prospective multicenter validation for two-day mortality
3. del Pozo Vegas et al., BMC Medicine, publication year not provided -- Prospective multicenter study of the Occult Hypoperfusion Index
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