Short Attention Span Summary
Get off my qSOFA
The quick sequential organ failure assessment (qSOFA) was favored in the most recent sepsis definitions. It is easy to calculate, 1 point for each: altered mental status, RR ≥ 22, SBP ≤ 100. The more points, from 0-3, the higher the rate of mortality, ICU admission, and hospital length of stay for patients both with and without infection in this single-center, retrospective study. Of note, a recent study in Chest found qSOFA specificity to be high but sensitivity lacking, calling it into question as a good screening tool for sepsis. For us in the ED, patients with altered mental status, tachypnea, or relatively low blood pressure deserve a second look and consideration for admission, especially if more than one of those variables is present. But did we really need this study to tell us that?
qSOFA in the ED was associated with mortality, ICU admission, and length of stay.
Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection. Ann Emerg Med. 2017 Apr;69(4):475-479. doi: 10.1016/j.annemergmed.2016.10.007. Epub 2017 Jan 19.
- EM Nerd Rory Spiegel has a post worth your time on the qSOFA, with this great quote, "...while qSOFA and the SIRS criteria are both reasonable from a triage perspective... neither will stand up to the clinical judgment of an experienced Emergency Physician doing what he or she is trained to do, to differentiate the sick from the not sick."
- Don't miss EMLoN on three qSOFA studies, including this one.