Comparing Quick Sequential Organ Failure Assessment Scores to End-tidal Carbon Dioxide as Mortality Predictors in Prehospital Patients with Suspected Sepsis

INTRODUCTION: Early identification of sepsis significantly improves outcomes, suggesting a role for prehospital screening. An end-tidal carbon dioxide (ETCO(2)) value ≤ 25 mmHg predicts mortality and severe sepsis when used as part of a prehospital screening tool. Recently, the Quick Sequential Organ Failure Assessment (qSOFA) score was also derived as a tool for predicting poor outcomes in potentially septic patients. METHODS: We conducted a retrospective cohort study among patients transported by emergency medical services to compare the use of ETCO(2) ≤ 25 mmHg with qSOFA score of ≥ 2 as a predictor of mortality or diagnosis of severe sepsis in prehospital patients with suspected sepsis. RESULTS: By comparison of receiver operator characteristic curves, ETCO(2) had a higher discriminatory power to predict mortality, sepsis, and severe sepsis than qSOFA. CONCLUSION: Both non-invasive measures were easily obtainable by prehospital personnel, with ETCO(2) performing slightly better as an outcome predictor.