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Prospective evaluation of the quickSOFA score as a screening for sepsis in the emergency department

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Abstract

In 2016, the new bedside tool quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) was presented to identify patients at high risk of developing sepsis or adverse outcome. The aim of this study was to investigate the diagnostic performance of the qSOFA scoring system as a screening in patients presenting at an emergency department (ED) of any cause. Therefore, we compared qSOFA with the systemic inflammatory response syndrome (SIRS) criteria and two modifications of qSOFA score. This is a prospective single-center study including patients presenting to the ED of any non-traumatic cause. Primary outcome was development of sepsis within 48 h, secondary outcomes were 30-day mortality and ICU stay for > 3 days. Data were collected within one hour after arrival to indicate an impression of initial medical contact. Among 1,668 patients, 105 sepsis cases were identified. 8.4% presented with qSOFA ≥ 2, 27.2% with SIRS ≥ 2 within one hour. Sensitivity of qSOFA in predicting sepsis was lower compared to the SIRS criteria. qSOFA showed better prognostic accuracy for 30-day mortality compared to SIRS (p < 0.05), but not for prolonged ICU stay (p = 0.56). Modification of qSOFA in replacing GCS by other scoring systems recording altered mental status did not improve its sensitivity. The qSOFA score has poor sensitivity to identify patients at risk of developing sepsis and can therefore not be considered as an adequate screening for sepsis in patients presenting to the ED. Furthermore, a positive qSOFA at arrival at the ED showed no sufficient reliability in detecting patients with adverse clinical course.

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Abbreviations

AUC:

Area under the receiver operating characteristic curve

CI:

Confidence interval

ED:

Emergency department

ESI:

Emergency Severity Index

GCS:

Glasgow Coma Scale

ICD-10:

International Classification of Diseases (ICD)-10

ICU:

Intensive care unit

IQR:

Interquartile range

LR + :

Positive Likelihood ratio

LR−:

Negative Likelihood ratio

NPV:

Negative predictive value

PPV:

Positive predictive value

qSOFA:

Quick Sequential (Sepsis-related) Organ Failure Assessment

qSOFAOx4 :

Modified qSOFA with parameter mental orientation instead of GCS

qSOFARASS :

Modified qSOFA with parameter RASS instead of GCS

RASS:

Richmond Agitation Sedation Scale

ROC:

Receiver-Operator-Characteristic curve

SIRS:

Systemic Inflammatory Response Syndrome

SOFA:

Sequential (Sepsis-related) Organ Failure Assessment

SpO2 :

Peripheral oxygen saturation

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Acknowledgements

The authors thank the staff of the Emergency Department of the University Hospital of Freiburg for their help in data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Emergency Medicine, Medical Center, University Hospital of Freiburg, Faculty of Medicine, University of Freiburg, Sir-Hans-A.-Krebs-Str., 79106, Freiburg im Breisgau, Germany

    Monika Loritz, Hans-Jörg Busch & Katrin Fink

  2. Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany

    Thomas Helbing

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  1. Monika Loritz
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  2. Hans-Jörg Busch
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Contributions

ML was responsible for the acquisition and the analysis of data as well as for the writing of the manuscript. HB was responsible for the conception of the study and participated substantially in analysis and interpretation of data. TH was responsible for analysis and interpretation of data. KF was responsible for the conception and the design of the study, for the analysis, and interpretation of data as well as for the writing of the manuscript. All authors read and approved the final manuscript for publication.

Corresponding author

Correspondence to Katrin Fink.

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Conflict of interest

The authors declare they have no competing interest.

Ethical approval

The study was approved by the ethics committee of the University Medical Center Freiburg (approval number 330/17) in advance and conforms to the Declaration of Helsinki. The trial was registered in advance in the German Clinical Trials Register (DRKS00012732).

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the University Medical Center Freiburg-approval number 330/17) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. According to the statement of the ethics committee there patients’ approval was waived because no examinations and measurements beyond the routine monitoring at the ED were performed and recorded.

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Loritz, M., Busch, HJ., Helbing, T. et al. Prospective evaluation of the quickSOFA score as a screening for sepsis in the emergency department. Intern Emerg Med 15, 685–693 (2020). https://doi.org/10.1007/s11739-019-02258-2

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