Use of prehospital qSOFA in predicting in-hospital mortality in patients with suspected infection: A retrospective cohort study

Abstract

Background The quick sequential organ failure assessment (qSOFA) score has recently been introduced to the emergency department (ED) and wards, and it predicted a higher number of deaths among patients with sepsis compared with baseline risk. However, studies about the application of the qSOFA score are limited in prehospital settings. Thus, this study aimed to assess the performance of prehospital qSOFA score in predicting the risk of mortality among patients with infection. Methods This single center, retrospective cohort study was conducted in a Japanese tertiary care teaching hospital between April 2016 and March 2017. We enrolled all consecutive adult patients transported to the hospital by ambulance and admitted to the ED due to a suspected infection. We calculated the prehospital qSOFA score using the first vital sign obtained at the scene by emergency medical service (EMS) providers. The primary outcome was in-hospital mortality. The Cox proportional hazards model was used to assess the association between prehospital qSOFA positivity and in-hospital mortality. Results Among the 925 patients admitted to the ED due to a suspected infection, 51.1% (473/925) were prehospital qSOFA-positive and 48.9% (452/925) were prehospital qSOFA-negative. The in-hospital mortality rates were 14.0% (66/473) in prehospital qSOFA-positive patients and 6.0% (27/452) in prehospital qSOFA-negative patients. The Cox proportional hazard regression model revealed a strong association between prehospital qSOFA score and in-hospital mortality (adjusted hazard ratio: 2.41, 95% confidence interval: 1.51–3.98; p <0.01). Conclusions Among the patients with suspected infection who were admitted at the ED, a strong association was observed between the prehospital qSOFA score and in-hospital mortality. In order to use this score in clinical practice, future study is necessary to evaluate how infection is suspected in the prehospital arena.

Severity scores in COVID-19 pneumonia: a multicenter, retrospective, cohort study

“…9,10 The multilobar infiltration, hypo-lymphocytosis, bacterial coinfection, smoking history, hypertension, and age (MuLBSTA) score, which is based on six parameters routinely measured in hospitals, is a new prognostic tool for patients hospitalized with viral pneumonia 11 and has been suggested as a severity score for patients with COVID-19. 5 The quick sequential organ failure assessment scale (qSOFA), based on the sepsis-3 definition, 12 has proven to be a useful tool in the emergency department, 13,14 non-intensive-care-unit (ICU) wards, 15,16,17 and even at home 18,19 for establishing a prognosis in patients with documented or suspected infection with different foci. Recent works indicate that qSOFA is also a useful tool for identifying patients with poor prognoses in viral infections such as influenza.…”

Febrile neutropenia in patients with acute myeloid leukemia: Outcome in relation to qSOFA score, C‐reactive protein, and blood culture findings

“…7 The score was found to be associated with increased infectious mortality in several studies among non-neutropenic patients. [8][9][10] There are only a few preliminary studies on implementation of qSOFA in FN of AML patients. 11,12 We postulated that qSOFA might be suitable for the assessment of infectious complications during FN in AML patients after intensive chemotherapy.…”

Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

“…In order to avoid this limitation, the 2016 “sepsis 3” conference defined a sepsis severity assessment tool named qSOFA score [ 8 ], usable both in the ED and in the pre-hospital setting. Nevertheless, its validity remains a matter of debate because conflicting results obtained with this score were observed between pre-hospital and ED studies [ 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. Thus, the use of biomarkers in a pre-hospital setting obtained with mobile devices seems promising to improve the diagnosis of sepsis and the evaluation of its severity.…”