Sepsis in Obstetrics Score (SOS) utility and validation for triaging patients with obstetric sepsis in the emergency department: Evidence from a low income health care setting.

BACKGROUND: Illness severity scores commonly used in critical care settings are not considered appropriate in obstetric practice as they do not account for pregnancy physiology. A new illness severity score called the 'Sepsis in Obstetrics Score' (SOS) was introduced by Albright et al. for triaging patients with sepsis in pregnancy in an emergency department setting.
OBJECTIVES: We aimed to determine whether this score could predict the need for critical care support using the presence of organ failure as the identification criteria. Severity and culture positivity in pregnancy-associated sepsis was also assessed.
MATERIALS AND METHODS: All pregnant, postabortal and postpartum women with suspected sepsis were enrolled (as per systemic inflammatory response syndrome criteria) were enrolled. Severe pregnancy-associated sepsis was defined as dysfunction of one or more organs due to sepsis. The severity of pregnancy-associated sepsis was graded according to the number of organ failures. A SOS cut off of 6 was taken for statistical analysis.
RESULTS: Out of 100 women with pregnancy-associated sepsis, 'severe sepsis' was present in 58%. When the SOS test performance was compared with the severity of pregnancy-associated sepsis, it had sensitivity of 68.9% and specificity of 80.9%, positive predictive value of 83% and negative predictive value 65% to predict severe sepsis. The area under curve for the SOS detecting severe pregnancy-associated sepsis was 0.810. SOS predicted organ failure in pregnancy-associated sepsis and this was statistically significant for all organs involved. Culture positivity did not correlate with the SOS in our study.
CONCLUSIONS: Sepsis in Obstetrics Score correlated well with organ failure in pregnancy-associated sepsis. It had a high positive predictive value (83%) for severe sepsis.