Abstract
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. This single-center, retrospective, cross-sectional study was conducted among patients who arrived via the emergency medical services (EMS). We calculated the qSOFA score and Modified Early Warning Score (MEWS) from prehospital records. We identified patients as infected if they received intravenous antibiotics at the emergency department or within the first 24 hours. 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 analysis was used to evaluate the qSOFA score and other risk factors. Out of 1574 prehospital patients, 47.1% were admitted and 3.2% died in the hospital. 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. 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 likelihood ratio test comparing the qSOFA- and qSOFA+ groups demonstrated significant improvement for noninfected patients (p <0.01). 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). 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.
Highlights
Physiological parameters are indicators of the patient’s health condition and are routinely used by emergency medical service (EMS) providers
Patients who were younger than 18 years (n = 235), had cardiopulmonary arrest (n = 4), and/or had missing values required for calculating the quick Sequential Organ Failure Assessment (qSOFA) score and Modified Early Warning Score (MEWS) (n = 57) were excluded
These results showed that qSOFA score is an independent prognostic factor for in-hospital mortality, especially in noninfected patients
Summary
Physiological parameters are indicators of the patient’s health condition and are routinely used by emergency medical service (EMS) providers. Early identification of high-risk patients is essential to transfer them appropriately and possibly to allow early intervention of emergency department (ED) staff. Scoring systems for vital signs such as the Modified Early Warning Score (MEWS) and National Early Warning Score (NEWS) have been developed for the hospital setting and are currently used in the prehospital setting to identify patients who require intensive care unit (ICU) admission, have adverse in-hospital events, or mortality [1,2,3]. The quick Sequential Organ Failure Assessment (qSOFA) score is a new tool for identifying critically-ill infected patients outside the ICU [4]. The qSOFA score was reported to be useful in predicting mortality in ED patients with and without infection [5]. Few studies have evaluated the utility of the qSOFA score in the prehospital setting
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