Abstract
BackgroundThe 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.MethodsThis 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.ResultsAmong 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).ConclusionsAmong 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.
Highlights
Sepsis is a global health burden with high prevalence and mortality rates
The Cox proportional hazard regression model revealed a strong association between prehospital qSOFA score and in-hospital mortality
Among the patients with suspected infection who were admitted at the emergency department (ED), a strong association was observed between the prehospital qSOFA score and in-hospital mortality
Summary
Sepsis is a global health burden with high prevalence and mortality rates. The time intervals from the first medical contact to the diagnosis of sepsis and the initiation of treatments, the rapid administration of antibiotic, were associated with lower mortality rates [1,2,3,4]. Seymour et al and Sepsis-3 Task Force have reported that qSOFA in the emergency department (ED) and wards predicted a higher number of deaths compared with baseline risk [2], and they recommended that the “qSOFA criteria should be used outside of the ICU to prompt clinicians to further investigate for organ dysfunction and to initiate or escalate therapy as appropriate.”. Several prehospital screening tools used for the identification of sepsis have been developed before the introduction of the qSOFA score. 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. This study aimed to assess the performance of prehospital qSOFA score in predicting the risk of mortality among patients with infection.
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