Looking Beyond Discrimination in Prehospital Scores to Improve Patient Outcomes

1

The mSOFA score uses five first-contact variables and showed an AUROC of 0.944 for two-day mortality in a prospective validation of more than 12,000 patients.
2

In a prospective multicenter study of 16,106 patients, 85 died despite having an mSOFA score below the high-acuity threshold of 5.
3

Among false-negative patients, lactate and GCS had a strong positive association, consistent with but not establishing occult hypoperfusion.
4

The Occult Hypoperfusion Index is lactate × (16 − GCS), with a threshold of 3.38 proposed as a secondary screen for patients with mSOFA below 5.
5

The OHI detected 73 of 85 deaths missed by mSOFA, increasing sensitivity from 90.9% to 98.7%, but its 2.4% mortality positive predictive value warrants evaluation of operational value.

1