Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Jun 9;25(1):56.
doi: 10.1186/s13049-017-0399-4.

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department

Åsa Askim  1   2   3 , Florentin Moser  4 , Lise T Gustad  5   6   7 , Helga Stene  8 , Maren Gundersen  8 , Bjørn Olav Åsvold  9   10   7 , Jostein Dale  4 , Lars Petter Bjørnsen  4 , Jan Kristian Damås  11   12   7 , Erik Solligård  13   4   5   7
Affiliations
Observational Study

Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department

Åsa Askim et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: We aimed to evaluate the clinical usefulness of qSOFA as a risk stratification tool for patients admitted with infection compared to traditional SIRS criteria or our triage system; the Rapid Emergency Triage and Treatment System (RETTS).

Methods: The study was an observational cohort study performed at one Emergency Department (ED) in an urban university teaching hospital in Norway, with approximately 20,000 visits per year. All patients >16 years presenting with symptoms or clinical signs suggesting an infection (n = 1535) were prospectively included in the study from January 1 to December 31, 2012. At arrival in the ED, vital signs were recorded and all patients were triaged according to RETTS vital signs, presenting infection, and sepsis symptoms. These admission data were also used to calculate qSOFA and SIRS. Treatment outcome was later retrieved from the patients' electronic records (EPR) and mortality data from the Norwegian population registry.

Results: Of the 1535 admitted patients, 108 (7.0%) fulfilled the Sepsis2 criteria for severe sepsis. The qSOFA score ≥2 identified only 33 (sensitivity 0.32, specificity 0.98) of the patients with severe sepsis, whilst the RETTS-alert ≥ orange identified 92 patients (sensitivity 0.85, specificity 0.55). Twenty-six patients died within 7 days of admission; four (15.4%) of them had a qSOFA ≥2, and 16 (61.5%) had RETTS ≥ orange alert. Of the 68 patients that died within 30 days, only eight (11.9%) scored ≥2 on the qSOFA, and 45 (66.1%) had a RETTS ≥ orange alert.

Discussion: In order to achieve timely treatment for sepsis, a sensitive screening tool is more important than a specific one. Our study is the fourth study were qSOFA finds few of the sepsis cases in prehospital or at arrival to the ED. We add information on the RETTS triage system, the two highest acuity levels together had a high sensitivity (85%) for identifying sepsis at arrival to the ED - and thus, RETTS should not be replaced by qSOFA as a screening and trigger tool for sepsis at arrival.

Conclusion: In this observational cohort study, qSOFA failed to identify two thirds of the patients admitted to an ED with severe sepsis. Further, qSOFA failed to be a risk stratification tool as the sensitivity to predict 7-day and 30-day mortality was low. The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria.

Keywords: Emergency Department (ED); Prospective; Rapid emergency triage and treatment system (RETTS); Sepsis; Systemic inflammatory response syndrome (SIRS); quick-SOFA (q-sofa).

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Overview of the different risk stratification tools for sepsis
Fig. 2
Fig. 2
Patient recruitment and information on missing data by severity of illness scoring system in ED
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, Rubenfeld G, Kahn JM, Shankar-Hari M, Singer M, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):762–774. doi: 10.1001/jama.2016.0288. - DOI - PMC - PubMed
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Simpson SQ. New sepsis criteria: a change we should not make. Chest. 2016;149(5):1117–1118. doi: 10.1016/j.chest.2016.02.653. - DOI - PubMed
    1. Cortes-Puch I, Hartog CS. Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights. Am J Respir Crit Care Med. 2016;194(1):16–18. doi: 10.1164/rccm.201604-0734ED. - DOI - PMC - PubMed
    1. Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, Edelson DP. qSOFA, SIRS, and early warning scores for detecting clinical deterioration in infected patients outside the ICU. Am J Respir Crit Care Med. 2016;195(7):906–911. - PMC - PubMed

Publication types

MeSH terms