PONE-D-20-14432

The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: an observational study

PLOS ONE

Dear Dr. Hanson,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jul 24 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Biswadev Mitra, MBBS, MHSM, PhD, FACEM

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

Reviewer #3: I Don't Know

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to review this important piece of work. The single centre retrospective study presents original research, not elsewhere reported, comparing the ability of several mortality predicting scoring tools to predict mortality in ICU and at 90 days in Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians, with sepsis. The authors report a similar predictive ability of the ANZROD, APACHE II, APACHE III, SAPS 2, qSOFA and SOFA scores in predicting death in Indigenous and non-Indigenous patients with sepsis over a 3-4 year period.

I have made several comments for the authors to consider in the attached PDF manuscript file and it may be easier for the authors to review this as opposed to me listing all of the notations here, but I outline major concerns below, in addition to minor concerns (highlighted with comments in the attached PDF).

1. Taking into account the NHMRC guideline on ethical conduct in research with Aboriginal and Torres Strait Islander peoples and communities I am curious as to whether the authors are familiar with this document and/or whether any Aboriginal and/or Torres Strait Islander peoples or communities were involved in any aspect of the study or in drafting of the manuscript?

The six core guiding principles of this guideline are key to any research undertaken with Aboriginal and Torres Strait Islander people and communities, however it was not clear from the manuscript whether the authors have considered these principles:

• respects the shared values of Aboriginal and Torres Strait Islander Peoples

• is relevant for Aboriginal and Torres Strait Islander priorities, needs and aspirations

• develops long-term ethical relationships among researchers, institutions and sponsors

• develops best practice ethical standards of research.

I recommend the authors consider these guidelines and incorporate a reflection of how they have considered these guidelines into the manuscript; methods, results and discussion. If there has not been any consultation with Indigenous persons regarding the research, this is a major limitation (and justification for rejection of the manuscript) and should be added to the limitations within the discussion. I suggest, if the journal has not already done so, that they consider enlisting an Aboriginal and/or Torres Strait Islander researcher to review this article and provide comment from an Aboriginal and/or Torres Strait Islander perspective. I am happy to make recommendations of appropriate reviewers, if needed.

2. The authors state that the primary objective of the study was to compare mortality predicting scoring systems in Indigenous and non-indigenous Australians. However, I feel the methods and results also emphasize understanding important characteristics of the populations and comparisons of these populations and that this should be considered.

I would be happy to review an edited version of the manuscript should the journal be able to seek peer review from an Aboriginal and/or Torres Strait Islander researcher.

Reviewer #2: Although Aboriginal and Torres Strait Islander is longer to write it is the preferred terminology for Aboriginal and Torres Strait Islander people in Australia. Please change throughout the paper. Another preferred terminology that you might like to use is Australia's First Nation people.

Line 186 page 8

Please indicate what supportive care means

Line 221 page 10

Different font colour

Line 231 page 10

“It is the only part of Australia which has the homelands of both Aboriginal and Torres Strait Islander Australians, peoples that are frequently conflated but who are ethnologically quite distinct”

Has “conflated” been recognised and confirmed by the community members? This can’t be just assumed. If this has not had input from community members, please remove word from this sentence.

“ethnologically” This word is a derogative term please remove it.

This sentence needs rewording to capture Aboriginal and Torres Strait Islander people’s distinct cultural groups.

Reviewer #3: The information provided with this article is not new to anyone familiar with the health determinants of the Australian Indigenous population in North Australia.

However, I think it is important to publish this research as it will stress/reiterate the need for more research and also the feasibility of using scoring systems for comparison of patient for multicentre research as well as country wide and internationally.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Ulrich Orda, NWHHS, James Cook University, Australia

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: PONE-D-20-14432_reviewer_comments.pdf

Attachment

Submitted filename: PLOS review PONE-D-20-14432 20200609.docx

PONE-D-20-14432R1

The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: an observational study

PLOS ONE

Dear Dr. Hanson,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Aug 16 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Biswadev Mitra, MBBS, MHSM, PhD, FACEM

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: I Don't Know

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: This is a very important subject for Aboriginal and Torres Strait Islander people and this manuscript has covered the subject well. The manuscript is well written and should be published.

Reviewer #3: I think there is a typo in line 278.

shouldn't it read: "... and have a significantLY HIGHER comorbidity ...

Two other comments with the second read of the revised subscription (not necessarily for correction but if a revision is requested to consider:

1) The title of the manuscript focusses on predictive scoring systems.

The conclusion however discusses in its first sentence the case fatality and that the Indigenous patients die at a younger age. Whilst this is a very important fact / statement (and not new), this was not the question of this study. The conclusion in regard to the question of the study is mentioned (like a dependend variable) in the second sentence / statement. Would it be worth to swab them?

2) I still think that from 2014 - 2017 Cairns Hospital was NOT addressed as a Tertiary Hospital but as a retrieval "base" hospital. This is reflected by the CSCF (and also the ACEM accreditation for their Emergency Department) I know that there is a recent push / move towards addressing Cairns Hospital as a Tertiary facility (despite the lack of especially neurosurgery and cardiothoracic surgery)- but this was definitely not applicable at the time where the study data were collected,

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

The applicability of commonly used predictive scoring systems in Indigenous Australians with sepsis: an observational study

PONE-D-20-14432R2

Dear Dr. Hanson,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Biswadev Mitra, MBBS, MHSM, PhD, FACEM

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: