Validation of 'Quick Sequential Organ Failure Assessment Score' as a Screening Tool for Early Identification of Sepsis Patients in the Emergency Department

Sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year. The speed and appropriateness of therapy administered in the initial hours of treatment are likely to influence the outcome. We conducted a study to validate the clinical assessment score named 'quick sequential organ failure assessment' (qSOFA) score for use in the early identification of sepsis patients in the emergency department. Our primary objective was to see the sensitivity and specificity of the qSOFA-score for diagnosing sepsis in the emergency department and our secondary objective was to compare the sensitivity of the qSOFA score with the National Early Warning (NEW) score in patients with sepsis. A prospective observational study was conducted at Max Super Speciality Hospital Saket, New Delhi, from July 2016 to January 2017. Adult patients presenting to the emergency department with clinical signs and symptoms suggestive of infection were enrolled as per the eligibility criteria and divided into two groups on the basis of their qSOFA score at presentation. Out of 120 patients who had a positive qSOFA score 30 were subsequently confirmed as having sepsis whereas in qSOFA negative group 14 patients were subsequently diagnosed as having sepsis. This leads to the fact that although the test has near-acceptable specificity, the sensitivity is quite low. Calculations of the secondary outcome, that is 28-day mortality, revealed that 17 patients out of 120 who had a positive qSOFA score died within 28 days of first presentation whereas in the control group, nine patients had died. This means it successfully predicted mortality in only 17 patients and failed to predict mortality in nine patients out of 26 patients that died. The p-value is 0.097 which indicates both poor sensitivity as well as specificity for predicting mortality. We also compared qSOFA with the NEW score and found the latter to have a better sensitivity for detecting sepsis. This study shows that the qSOFA score, which has been specifically designed for early detection of sepsis patients in the emergency department or a pre-hospital setting in whom infection is suspected on a clinical basis, does not seem to be a good screening tool for early detection of sepsis patients in the emergency department.