COMMENTARY

Quick SOFA Scores May Predict Mortality in the ED

Sumit Patel, MD

Disclosures

May 16, 2017

Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection

Singer AJ, Ng J, Thode HC Jr, Spiegel R, Weingart S
Ann Emerg Med. 2017;69:475-479

Study Summary

In this retrospective single-center chart review study, researchers analyzed a total of 67,475 adult emergency department (ED) visits to calculate a quick Sequential Organ Failure Assessment (qSOFA) score with both vital signs and Modified Early Warning System (MEWS) scores. At the study institution, the MEWS score is a tool nurses use to monitor patients and allow early detection of impending decline in condition.

They excluded patients triaged to fast-track, dentistry, psychiatry, and labor and delivery. They also excluded 41,376 patients for whom vital signs were not entered within 2 minutes of entering a MEWS score. Another 3569 patients were excluded because they did not have a MEWS score calculated.

The final analysis group consisted of 22,530 patients. Researchers identified when patients received intravenous antibiotics, and this was used as a surrogate marker for presumed infection. Patients who did not receive intravenous antibiotics were assumed to not have an infection.

The primary outcome for the study was in-hospital mortality. Secondary outcomes included hospital admission, intensive care unit (ICU) admission, and total hospital length of stay, from ED triage to discharge from the hospital.

Using univariate and multivariate analyses, researchers found that increasing qSOFA scores were associated with increasing mortality, chance of ICU admission, and hospital length of stay. The sensitivity and specificity of a qSOFA score ≥ 2 for predicting mortality were 29% and 97%, respectively, with a negative predictive value of 99%. The sensitivity and specificity of a qSOFA score ≥ 1 were 71% and 74%, respectively, also with a negative predictive value of 99%.

Viewpoint

Previously, the qSOFA score had been identified as a tool to predict mortality and ICU admission for critically ill patients.[1,2] It has not been studied in an undifferentiated ED population, however.

This study shows promising predictive abilities for calculated qSOFA scores in ED patients. The qSOFA score offers significant advantages over other calculators and predictors, because it is based entirely on vital signs and physical examination that can be performed quickly regardless of setting and resource availability.

This study had limitations, including several biases that often affect retrospective chart review studies. A significant number of patients had to be excluded because they did not have all necessary vital signs and scores recorded, for example. The researchers attempted to account for this by analyzing the populations included and excluded, and ultimately stated that the study sample may have been a more ill population than the overall 67,475 patients. The study was also performed at a single suburban academic center in Long Island, New York, which may not be widely applicable.

This study certainly provides relevant statistical support behind the use of qSOFA in our undifferentiated ED patients to identify those who are risk for deterioration or in need of a higher level of care. Before it can be used widely, further validation studies in different patient populations are needed.

Abstract

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