This study aimed to determine the accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score in predicting mortality among prehospital patients with and without infection. In recent studies, the performance of the qSOFA score in predicting complications was evaluated only in prehospital patients with infection [Here, the performance of the qSOFA score in association with in-hospital mortality was useful in noninfected patients compared with infected patients.
These are outcomes that are more common in infected patients who may be septic than those with uncomplicated infection. To predict in-hospital mortality, each qSOFA score point and the MEWS were assessed using sensitivity, specificity, predictive values, and likelihood ratios. In a retrospective study conducted in the ED setting, Singer et al. Nevertheless, the prehospital qSOFA score was more accurate than the MEWS and physiological parameters in predicting in-hospital mortality in noninfected patients. The mortality rate in a tertiary care hospital in Japan is very high (9.1%) comprising 56% trauma patients; however, it includes only 3% infected patients [We found that this tool was not sufficient for predicting mortality in infected patients. The ED serves a population of 0.55 million. Out of 1574 prehospital patients, 47.1% were admitted and 3.2% died in the hospital. The likelihood ratio test comparing the qSOFA- and qSOFA+ groups demonstrated significant improvement for noninfected patients (p <0.01). We identified patients as infected if they received intravenous antibiotics at the emergency department or within the first 24 hours. The performance of the qSOFA score in predicting in-hospital mortality in noninfected patients was 0.70, higher than for each parameter and the MEWS. In cases where the physiological parameters do not match any row, zero points are given.
(A) qSOFA score vs. each physiologic parameter in all patients, noninfected patients, and infected patients; (B) qSOFA score vs. MEWS in the three groups. Receiver operating characteristic analysis was used to evaluate and compare the performance of the qSOFA score, each physiological parameter, and the MEWS in predicting admission and in-hospital mortality in patients with and without infection. Multivariate regression analysis for in-hospital mortality demonstrated that the qSOFA score is an independent prognosticator for in-hospital mortality, especially among noninfected patients (odds ratio, 3.60; p <0.01). The predictive validity of a qSOFA score ≥ 2 for in-hospital mortality was significantly greater than that of systemic inflammatory response syndrome (SIRS) and SOFA scores [ 6 ]. The Quick SOFA Score (quickSOFA or qSOFA) was introduced by the Sepsis-3 group in February 2016 as a simplified version of the SOFA Score as an initial way to identify patients at high risk for poor outcome with an infection. This single-center, retrospective, cross-sectional study was conducted among patients who arrived via the emergency medical services (EMS). All statistical analyses were performed using R version 3.4.1 (The R Development Core Team, Vienna, Austria).A total of 1870 patients presented to the ED via the EMS during the study period. The secondary outcome was hospital admission.Baseline characteristics were presented as medians and interquartile ranges for continuous variables and as number of patients for categorical variables.
In conclusion, the prehospital qSOFA score was associated with in-hospital mortality in noninfected patients and may be a beneficial tool for identifying deteriorating patients in the prehospital setting.Physiological parameters are indicators of the patient’s health condition and are routinely used by emergency medical service (EMS) providers. The areas under the curve for the qSOFA+ model vs. the qSOFA- model was 0.77 vs. 0.68 for noninfected patients (p <0.05) and 0.71 vs. 0.68 for infected patients (p = 0.41).
The Kruskal-Wallis test was performed to compare four score groups (qSOFA: 0, 1, 2, and 3) for continuous variables, and the chi-square test was used for categorical variables. In the prehospital setting, early identification of high-risk patients is essential to transfer them appropriately and possibly to allow early intervention of emergency department (ED) staff. This single-center, retrospective, cross-sectional study was conducted among patients who arrived via the emergency medical services (EMS). Thus, 1574 patients were included in the analysis (The results of the ROC analysis for admission in all patients, infected patients, and noninfected patients are shown in (A) qSOFA score vs. each parameter in all patients, noninfected patients, and infected patients; (B) qSOFA score vs. MEWS in the three groups. AUC, the area under the curve; qSOFA, quick Sequential Organ Failure Assessment.In this study, we found that the prehospital qSOFA score was associated with in-hospital mortality in noninfected patients compared to the MEWS and physiological parameters.Although the qSOFA score is a tool for identifying infected patients with high-risk outcomes outside the ICU, few studies have investigated its utility in the prehospital setting.
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