{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:56Z","timestamp":1787027336242,"version":"build-2736575974"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sepsis causes disproportionate mortality in low- and middle-income countries (LMICs), yet evidence on screening tool performance in these resource-limited settings remains fragmented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to evaluate and compare the diagnostic accuracy of sepsis screening tools\u2014ranging from purely clinical assessments (qSOFA, NEWS, MEWS, UVA) to those incorporating laboratory parameters (SIRS, SOFA)\u2014for sepsis identification in adult populations within LMICs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and Global Index Medicus was conducted from inception through June 2025. Eligible studies evaluated sepsis screening tools ranging from purely clinical bedside assessments (qSOFA, NEWS, MEWS, UVA) to those requiring basic laboratory parameters (SIRS, SOFA), enabling comparison across the resource-availability spectrum in LMICs. Bivariate random-effects models were employed to calculate pooled sensitivity, specificity, and area under the hierarchical summary receiver operating characteristic curve (AUROC). Evidence quality was assessed using the GRADE approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-seven studies encompassing 30,310 patients across 14 LMICs were included. qSOFA demonstrated pooled sensitivity of 0.51 (95% CI: 0.42\u20130.60) and specificity of 0.83 (95% CI: 0.77\u20130.88) with AUROC of 0.74. SIRS exhibited high sensitivity (0.86) but poor specificity (0.32). NEWS achieved the highest point estimate of discriminative ability (AUROC 0.77, 95% CI: 0.73\u20130.81), followed by SOFA (AUROC 0.75, 95% CI: 0.71\u20130.79) and UVA (AUROC 0.74, 95% CI: 0.70\u20130.78), although confidence intervals overlapped substantially across tools. qSOFA yielded a positive likelihood ratio (LR+) of 3.00 and a negative likelihood ratio (LR\u2212) of 0.59, indicating moderate rule-in but limited rule-out utility. Substantial heterogeneity was observed across studies (I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f&amp;gt;\u202f75%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>No single screening tool demonstrates optimal performance across all metrics in LMIC populations. When analysis is restricted to purely clinical tools requiring no laboratory parameters, NEWS (AUROC 0.77) and qSOFA (AUROC 0.74) demonstrate comparable discriminative ability with broadly overlapping confidence intervals, supporting their consideration in the most resource-constrained settings. However, the limited rule-out capacity of qSOFA (LR\u202f\u2212\u202f0.59) suggests it should not be used as a standalone screening tool. Tool selection should be guided by local healthcare priorities and available laboratory capacity, with tiered screening strategies potentially optimizing sepsis recognition while ensuring efficient resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1782420","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:48:08Z","timestamp":1779256088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Sepsis screening tools in resource-limited settings: a systematic review and meta-analysis of diagnostic accuracy in low- and middle-income countries"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiale","family":"Tong","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]},{"name":"Institute of Disaster Medicine, Sichuan University","place":["Chengdu, China"]},{"name":"Nursing Key Laboratory of Sichuan Province, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, West China Hospital, and Disaster Medical Center, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"456","DOI":"10.3390\/epidemiologia5030032","article-title":"The global burden of sepsis and septic shock","volume":"5","author":"La Via","year":"2024","journal-title":"Epidemiologia"},{"key":"ref2","volume-title":"Improving the prevention, diagnosis and clinical management of sepsis: report by the Secretariat (EB140\/12)","year":"2017"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref4","volume-title":"Global Report on the Epidemiology and Burden on Sepsis: current Evidence, Identifying gaps and Future Directions","author":"Cassini","year":"2020"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e1063","DOI":"10.1097\/CCM.0000000000005337","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","volume":"49","author":"Evans","year":"2021","journal-title":"Crit Care Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e0592","DOI":"10.1097\/CCE.0000000000000592","article-title":"Epidemiology and outcome of Sepsis in adults and children in a rural, sub-Sahara African setting","volume":"3","author":"Kwizera","year":"2021","journal-title":"Crit Care Explor"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2646","DOI":"10.21037\/tp-20-310","article-title":"Challenges and solutions in translating sepsis guidelines into practice in resource-limited settings","volume":"10","author":"Ranjit","year":"2021","journal-title":"Transl Pediatr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e70045","DOI":"10.1002\/ams2.70045","article-title":"Sepsis in Global Health: current global strategies to fight against sepsis","volume":"12","author":"Saito","year":"2025","journal-title":"Acute Med Surg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e0266755","DOI":"10.1371\/journal.pone.0266755","article-title":"A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: a meta-analysis","volume":"17","author":"Wang","year":"2022","journal-title":"PLoS One"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1802707","DOI":"10.1155\/2022\/1802707","article-title":"Prognostic accuracy of qSOFA and SIRS for mortality in the emergency department: a meta-analysis and systematic review of prospective studies","volume":"2022","author":"Ruan","year":"2022","journal-title":"Emerg Med Int"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1080\/14787210.2023.2237192","article-title":"SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis","volume":"21","author":"Qiu","year":"2023","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0265713","DOI":"10.1371\/journal.pone.0265713","article-title":"Performance of the universal vital assessment (UVA) mortality risk score in hospitalized adults with infection in Rwanda: a retrospective external validation study","volume":"17","author":"Hazard","year":"2022","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jhin.2023.11.012","article-title":"Prevalence and mortality rate of sepsis among adults admitted to hospitals in sub-Saharan Africa: a systematic review and meta-analysis","volume":"144","author":"Kiya","year":"2024","journal-title":"J Hosp Infect"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0264517","DOI":"10.1371\/journal.pone.0264517","article-title":"Emergency care of sepsis in sub-Saharan Africa: mortality and non-physician clinician management of sepsis in rural Uganda from 2010 to 2019","volume":"17","author":"Rice","year":"2022","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3188","DOI":"10.3390\/jcm12093188","article-title":"2023 update on sepsis and septic shock in adult patients: management in the emergency department","volume":"12","author":"Guarino","year":"2023","journal-title":"J Clin Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"67","DOI":"10.20471\/acc.2022.61.s1.11","article-title":"Sepsis definition: what\u2019s new in the treatment guidelines","volume":"61","author":"Srzi\u0107","year":"2022","journal-title":"Acta Clin Croat"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"398","DOI":"10.2471\/BLT.20.276709","article-title":"Future directions and priorities in sepsis epidemiology research: a call for action","volume":"99","author":"Cassini","year":"2021","journal-title":"Bull World Health Organ"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1186\/s13054-015-0826-8","article-title":"A simple prognostic index based on admission vital signs data among patients with sepsis in a resource-limited setting","volume":"19","author":"Asiimwe","year":"2015","journal-title":"Crit Care"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.tjem.2018.08.002","article-title":"Comparison of qSOFA and SOFA score for predicting mortality in severe sepsis and septic shock patients in the emergency department of a low middle income country","volume":"18","author":"Baig","year":"2018","journal-title":"Turk J Emerg Med"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e067840","DOI":"10.1136\/bmjopen-2022-067840","article-title":"Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study","volume":"13","author":"Blair","year":"2023","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e0197982","DOI":"10.1371\/journal.pone.0197982","article-title":"Prognostic value of quickSOFA as a predictor of 28-day mortality among febrile adult patients presenting to emergency departments in Dar es salaam, Tanzania","volume":"13","author":"Boillat-Blanco","year":"2018","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.4269\/ajtmh.17-0682","article-title":"Predicting mortality for adolescent and adult patients with fever in resource-limited settings","volume":"99","author":"Carugati","year":"2018","journal-title":"Am J Trop Med Hyg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1186\/s12879-018-3448-3","article-title":"Clinical characteristics, organ failure, inflammatory markers and prediction of mortality in patients with community acquired bloodstream infection","volume":"18","author":"Dat","year":"2018","journal-title":"BMC Infect Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e0247646","DOI":"10.1371\/journal.pone.0247646","article-title":"Clinical and microbiological characterization of sepsis and evaluation of sepsis scores","volume":"16","author":"Fuchs","year":"2021","journal-title":"PLoS One"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12873-020-00337-8","article-title":"The utility of red cell distribution width to predict mortality of septic patients in a tertiary hospital of Nepal","volume":"20","author":"Ghimire","year":"2020","journal-title":"BMC Emerg Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"11","DOI":"10.21776\/ub.jkb.2024.033.01.3","article-title":"Modification of qSOFA increases mortality prediction accuracy in sepsis patients","volume":"33","author":"Gunawan","year":"2024","journal-title":"J Kedokt Brawijaya"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s15010-017-1057-5","article-title":"Application of the qSOFA score to predict mortality in patients with suspected infection in a resource-limited setting in Malawi","volume":"45","author":"Huson","year":"2017","journal-title":"Infection"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"896","DOI":"10.4269\/ajtmh.19-0320","article-title":"The prevalence and outcomes of Sepsis in adult patients in two hospitals in Malawi","volume":"102","author":"Kayambankadzanja","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"191","DOI":"10.4314\/gmj.v56i3.9","article-title":"Comparison of qSOFA score, SIRS criteria, and SOFA score as predictors of mor-tality in patients with sepsis","volume":"56","author":"Khan","year":"2022","journal-title":"Ghana Med J"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e20109","DOI":"10.7717\/peerj.20109","article-title":"Predictive performance of clinical scores and survival outcomes in critically ill patients with sepsis: a prospective longitudinal study at a tertiary medical Centre in Ethiopia","volume":"13","author":"Kiya","year":"2025","journal-title":"PeerJ"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e040361","DOI":"10.1136\/bmjopen-2020-040361","article-title":"Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores","volume":"11","author":"Klinger","year":"2021","journal-title":"BMJ Open"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"161","DOI":"10.4103\/jets.jets_37_23","article-title":"Quick sequential organ failure assessment score, lactate, and neutrophil-lymphocyte ratio help in diagnosis and mortality prediction during Golden hour of Sepsis in emergency department","volume":"16","author":"Kumar","year":"2023","journal-title":"J Emerg Trauma Shock"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0228966","DOI":"10.1371\/journal.pone.0228966","article-title":"The inability to walk unassisted at hospital admission as a valuable triage tool to predict hospital mortality in Rwandese patients with suspected infection","volume":"15","author":"Kwizera","year":"2020","journal-title":"PLoS One"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s40560-018-0279-7","article-title":"Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study","volume":"6","author":"Lie","year":"2018","journal-title":"J Intensive Care"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"7971387","DOI":"10.1155\/2020\/7971387","article-title":"A descriptive study on Sepsis: causes, outcomes, and adherence to guidelines on patients with sepsis at a tertiary care hospital in Sri Lanka","volume":"2020","author":"Matthias","year":"2020","journal-title":"Biomed Res Int"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e000344","DOI":"10.1136\/bmjgh-2017-000344","article-title":"Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa","volume":"2","author":"Moore","year":"2017","journal-title":"BMJ Glob Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1001\/jama.2018.6229","article-title":"Association of the quick sequential (sepsis-related) organ failure assessment (qSOFA) score with excess hospital mortality in adults with suspected infection in low- and middle-income countries","volume":"319","author":"Rudd","year":"2018","journal-title":"JAMA"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e9030","DOI":"10.7759\/cureus.9030","article-title":"The utility of early warning score in adults presenting with sepsis in the emergency department of a low resource setting","volume":"12","author":"Siddiqui","year":"2020","journal-title":"Cureus"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1136\/emermed-2018-208361","article-title":"Prognostic accuracy of the quick sequential organ failure assessment (qSOFA)-lactate criteria for mortality in adults with suspected bacterial infection in the emergency department of a hospital with limited resources","volume":"37","author":"Sinto","year":"2020","journal-title":"Emerg Med J"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1186\/s12879-025-12046-3","article-title":"The predictive performance of NEWS, MEWS, SOFA and SAPS II in outcomes of bacteremic and non-bacteremic sepsis","volume":"25","author":"Talkar","year":"2025","journal-title":"BMC Infect Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/jets.jets_99_22","article-title":"Performance of qSOFA score as a screening tool for sepsis in the emergency department","volume":"16","author":"Tiwari","year":"2023","journal-title":"J Emerg Trauma Shock"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1186\/s13054-024-05176-8","article-title":"A multicentre prospective registry of one thousand sepsis patients admitted in Indian ICUs: (SEPSIS INDIA) study","volume":"28","author":"Todi","year":"2024","journal-title":"Crit Care"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4103\/ijciis.ijciis_41_22","article-title":"National early warning score 2 is superior to quick sequential organ failure assessment in predicting mortality in sepsis patients presenting to the emergency department in India: a prospective observational study","volume":"13","author":"Verma","year":"2023","journal-title":"Int J Crit Illn Inj Sci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e1281","DOI":"10.1016\/S2214-109X(22)00277-7","article-title":"Enhanced bedside mortality prediction combining point-of-care lactate and the quick sequential organ failure assessment (qSOFA) score in patients hospitalised with suspected infection in Southeast Asia: a cohort study","volume":"10","author":"Wright","year":"2022","journal-title":"Lancet Glob Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1782420\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:48:09Z","timestamp":1779256089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1782420\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2026.1782420"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1782420","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"article-number":"1782420"}}