Is qSOFA the ‘Holy Grail’ of Sepsis Research?

  The Research Dorsett M, Kroll M, Smith C, et al. qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care. 2017;21(4):489–497. The Science The authors reviewed the medical records, including the EMS report, of 152 patients arriving by EMS at a large urban ED and who were diagnosed with an infection (n = 71), sepsis (n = 38) or severe sepsis (n = 43). The records were examined for signs and symptoms that are components of a sepsis scoring scheme called quick sequential organ failure assessment (qSOFA), which could’ve been performed by the EMS providers. The qSOFA score ranges from 0 to 3, with one point awarded for each of the following, if present on exam: Systolic blood pressure < 100 mmHg; respiratory rate > 22 and altered mental status. A score of 2 or 3 has been proposed to correlate with the presence of sepsis. They discovered that an EMS score of 2 was 16.3% sensitive (95% confidence interval [CI] 6.8–30.7%) and 97.3% specific (95% CI 92.1–99.4%) for patients confirmed to have severe sepsis. Had the medics been allowed to add an additional point for such things as a pulse over 100, nursing home residence, age > 50, or history of a fever, the sensitivity of the qSOFA would’ve increased to 58.1% (95% CI 42.1–73.0%), but decreased the specificity to 78.0% (95% CI 69.0–85.4%) During their stay in the ED, two-thirds of patients who met the EMS qSOFA criteria developed sufficient symptoms to ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Patient Care Columns Source Type: news