The quick Sequential Organ Failure Assessment, or qSOFA, is a tool healthcare professionals use at a patient’s bedside to quickly identify patients with a suspected infection who are more likely to have poor outcomes. This rapid screening method is for flagging high-risk individuals in settings outside an intensive care unit (ICU), like an emergency department, helping clinicians recognize worsening conditions without delay.
The Three Clinical Criteria
One criterion is an assessment of a patient’s mental status, referred to as altered mentation. This looks for any acute change from a person’s normal level of alertness. Clinicians often use the Glasgow Coma Scale (GCS), a 15-point test assessing eye, verbal, and motor responses. A GCS score of less than 15 indicates altered consciousness, such as new-onset confusion or significant drowsiness, and satisfies this qSOFA criterion.
Another criterion is a fast respiratory rate, which is a measurement of how many breaths a patient takes per minute. For the qSOFA assessment, a rate of 22 breaths per minute or higher is the threshold. An elevated respiratory rate, or tachypnea, can be an early sign that the body is working harder to get oxygen due to a stressor like an infection.
The final criterion is low blood pressure. This is met if a patient’s systolic blood pressure is 100 millimeters of mercury (mm Hg) or less. Systolic pressure, the top number in a blood pressure reading, measures the force the heart exerts on the walls of the arteries each time it beats. A low reading can indicate the circulatory system is under strain from fighting a severe infection.
Interpreting the Score and Its Purpose
The qSOFA score is calculated by assigning one point for each criterion a patient meets, resulting in a score from 0 to 3. A patient with a respiratory rate of 24, a systolic blood pressure of 95 mm Hg, and who is fully alert would have a qSOFA score of 2.
A score of 2 or more suggests a higher likelihood of prolonged ICU stays or death for patients with an infection. The qSOFA score is not a diagnostic tool for sepsis and does not confirm its presence. Instead, it functions as a prompt, signaling to healthcare providers that further investigation for organ dysfunction is warranted.
This may involve ordering laboratory tests, initiating more intensive monitoring, and considering more aggressive treatments. The score acts as an early warning system to ensure high-risk patients receive timely medical attention before their condition worsens.
Distinctions from the Full SOFA Score
The qSOFA score is a simplified version of the more comprehensive Sequential Organ Failure Assessment (SOFA) score. The qSOFA is designed for rapid screening in any clinical setting, such as an emergency room or general hospital ward, without needing lab results. This simplicity allows for quick identification of patients who might be developing sepsis.
In contrast, the full SOFA score is a more detailed system used to track the status of critically ill patients, typically within an ICU. It assesses the function of six different organ systems: respiratory, cardiovascular, liver, coagulation, kidney, and neurological. This detailed assessment requires multiple laboratory tests and provides a more granular view of a patient’s organ function over time.
The SOFA score produces a score ranging from 0 to 24, which helps clinicians in the ICU monitor the progression of organ failure and predict outcomes. While qSOFA is a quick prompt to consider sepsis, the full SOFA score is a tool for monitoring the severity of organ dysfunction once a patient is in a critical care environment.