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    qSOFA (Quick SOFA) Score for Sepsis

    Identifies high-risk patients for in-hospital mortality with suspected infection outside the ICU.
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    INSTRUCTIONS

    Use to predict mortality, NOT to diagnose sepsis, per 2017 Surviving Sepsis Guidelines.

    When to Use
    Pearls/Pitfalls
    Why 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.

    • 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 (March 2017) does not integrate the qSOFA Score in recommendations for screening or diagnosis of sepsis.
    • 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.
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    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.

    Management

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    Dr. Christopher Seymour
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