Triage of Sepsis Patients: Sirs or Qsofa – Which Is Best?

Abstract

Objectives & BackgroundRecent consensus guidelines have suggested using the qSOFA score as a tool for the identification of patients with sepsis outwith the ICU setting. In the UK, we currently use the SIRS criteria as a means of identifying these patients in the ED. We wanted to look at whether the qSOFA would reliably identify septic patients in our ED population.MethodsWe retrospectively reviewed 200 cases of adult patients presenting to our ED over a six month period who had a sepsis 6 form completed. SIRS and qSOFA scores were calculated for all patients and the results compared. Patients identified as requiring critical care input and those who died were noted.Results200 patients were identified over a 6 month period–109 male, 91 female; age range 18–95 yrs; average 66.7 yrs; IQR 1–58 yr; IQR 3–79 yrs.Of these 200 patients, 4 were admitted to ITU and 17 were admitted to HDU from the Emergency Department. There were 22 deaths in total of whom 1 died on ITU with full escalation of care, and 8 died in HDU with a decision they were not for further escalation. Of those that died outwith critical care, 8 had a decision of ward as ceiling of care made in the ED.195 cases were positive for SIRS of which 4 were admitted to ICU; 16 to HDU and 22 died. SIRS identified all patients who died and all but 1 patient who received critical care input.SIRS test was 97% sensitive and 2.4% specific. The positive predictive value is 15.9%, the negative predictive value is 80%.29 cases were positive for qSOFA of whom 1 was admitted to ICU and 9 to HDU. There were 9 deaths in this group of which 5 were patients on HDU. 4 patients identified as qSOFA positive were determined as not for escalation of care and subsequently died.qSOFA was 90% specific for identifying patients who died or required critical care input but only 48% sensitive. The positive predictive value is 42%, the negative predictive value is 92%.ConclusionqSOFA is a more specific test to identify patients requiring critical care input or at risk of death. Although SIRS is more sensitive, its lack of specificity makes it a much less effective screening tool for severe sepsis.Practically, SIRS is useful as a triage tool to identify potentially septic patients but once identified qSOFA should be used to assess severity and need for critical care involvement.

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

“…SIRS had a superior predictive value for both mortality and prolonged length of hospital stay, compared to qSOFA. This finding contrasts with that from previous studies [ 8 , 22 , 23 ]. SIRS was superior to qSOFA in predicting both mortality and prolonged hospital stay, in this study, consistent with the findings of Askim et al [ 22 ].…”

A Case of Severe Acute Respiratory Distress Syndrome Secondary to Atypical Amniotic Fluid Embolism

“…SIRS criteria are sensitive but lack specificity compared to qSOFA (Quick SOFA) criteria, and the patient met only one qSOFA criterion (RR > 22/min). Furthermore, she remained hemodynamically stable despite severe ARDS, and no definitive source of infection was found [ 6 ].…”

The challenge of recognising sepsis: Future nanotechnology solutions

“…To address this, the surviving sepsis guidelines recommend using the quick SOFA (qSOFA) tool; a 3-point scoring system designed to help clinicians identify patients at greater risk of mortality outside of intensive care. When used as a screening tool to identify patients who may have sepsis, qSOFA is more specific than the systemic inflammatory response syndrome (SIRS) score it replaced, 18 although its sensitivity is lower. 19 Early warning scores such as the National Early Warning Score-2 (NEWS2) are increasingly used in hospitals.…”