qSOFA (Quick SOFA) Score for Sepsis
Why Use
Identifies patients outside the ICU with suspected infection that are at a high risk for in-hospital mortality. Can help increase suspicion or awareness of a severe infectious process and prompt further testing and/or closer monitoring.
When to Use
Patients ≥18 years old in a non-ICU setting (i.e. pre-hospital, ward, emergency department, or step-down unit) with confirmed or suspected infection.
Formula
Pearls / Pitfalls
The qSOFA Score was introduced by the Sepsis-3 group as a simplified version of the SOFA Score , a validated ICU mortality prediction score, to help identify patients with suspected infection that are at high risk for poor outcome (defined as in-hospital mortality, or ICU length of stay ≥3 days) outside of the ICU. Simplifies the SOFA Score significantly by only including 3 clinical criteria easily assessed at the bedside. Can be repeated serially if there is a change in clinical condition. Predicts mortality, as opposed to diagnosing sepsis, and still has an unclear role in the sequence of events from screening to diagnosis to triggering of sepsis-related interventions. At this time, no prospective studies demonstrate that clinical decisions based on qSOFA lead to better patient outcomes. The latest version of the Surviving Sepsis Campaign guidelines (November 2021) does not integrate the qSOFA Score in recommendations for screening or diagnosis of sepsis.
Management
qSOFA is a mortality predictor, NOT a diagnostic test for sepsis. It is still not clear how it will be used in the sequence of events going from screening, to diagnosis of sepsis, to the triggering of sepsis-related interventions. The management of sepsis is continually evolving and is detailed in the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Advice
A “positive” qSOFA Score (≥2) suggests high risk of poor outcome in patients with suspected infection. These patients should be more thoroughly assessed for evidence of organ dysfunction. A positive qSOFA Score by itself should not trigger sepsis-directed interventions like initiation of broad-spectrum antibiotics; rather, it should prompt clinicians to further investigate for presence of organ dysfunction or to increase frequency of monitoring. The Sepsis-3 task force recommends that a positive qSOFA Score should prompt the calculation of a SOFA score to confirm the diagnosis of sepsis. This remains controversial, as qSOFA has been shown to be more predictive than SOFA outside of the ICU setting. Even if the qSOFA Score is initially “negative” (<2), it can be repeated if there is a change in the patient’s clinical status.
More Information
Interpretation: qSOFA Score Risk group 0-1 Not high risk for in-hospital mortality 2-3 High risk for in-hospital mortality (3- to 14-fold increase)