Prehospital and in‐hospital quick Sequential Organ Failure Assessment (qSOFA) scores to predict in‐hospital mortality among trauma patients: an analysis of nationwide registry data

AIM: The quick Sequential Organ Failure Assessment (qSOFA) score can be used to predict in‐hospital mortality in trauma patients. We sought to determine whether repeatedly calculating the qSOFA score improves its discriminative ability in predicting in‐hospital mortality in trauma patients. METHODS: We undertook a multicenter retrospective study, analyzing 90,974 trauma patients registered in the Japan Trauma Data Bank (a nationwide trauma registry) from 2004 to 2017. Patients included were ≥18 years old and transferred directly to hospitals from their respective scenes of injury. We calculated the qSOFA score at two time points: at the scene (prehospital qSOFA score) and on arrival at the hospital (hospital qSOFA score). We evaluated the discriminative ability of repeated calculations of the qSOFA score. The primary outcome in consideration was in‐hospital mortality. RESULTS: In‐hospital mortality occurred in 5604 patients (6.2%). The predictive accuracy of the hospital qSOFA score was higher than that of the prehospital qSOFA (area under the receiver operating characteristics curve [AUROC] 0.74 vs. 0.69, P < 0.0001) in predicting in‐hospital mortality. However, the mean qSOFA score had the highest predictive accuracy (AUROC 0.76, P < 0.0001). If the hospital qSOFA score was increased compared to the prehospital score, this indicated an approximately 2‐fold to 4‐fold increase in in‐hospital mortality. CONCLUSIONS: Repeated calculations of qSOFA score improved its ability to predict in‐hospital mortality in trauma patients. Specifically, we should consider an increasing qSOFA score as a “red flag” to clinicians in the emergency department.