Comparing Mortality Prediction by Quick Sequential Organ Failure Assessment with Emergency Physician Judgment

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Infectious Diseases

Background:

• The quick sequential organ failure assessment (qSOFA) is a tool to identify infected patients at risk of mortality in non-ICU settings.
• Early identification of sepsis is crucial for patient outcomes.

Purpose of the Study:

• To evaluate if the qSOFA score enhances physician prediction of mortality in infected Emergency Department (ED) patients.
• To compare the predictive performance of qSOFA, physician judgment, and their combination.

Main Methods:

• Secondary analysis of a prospective, observational study of potentially septic ED patients.
• Inclusion criteria: 2 or more systemic inflammatory response syndrome criteria with organ dysfunction, hypotension, or elevated lactate.
• Physician judgment for mortality and qSOFA scores were retrospectively calculated; logistic regression and bootstrapping were used for analysis.

Main Results:

• Of 195 analyzed infected patients, 16 (8.2%) experienced 28-day in-hospital mortality.
• qSOFA (AUC 0.63) was not superior to physician judgment (AUC 0.80) in predicting mortality.
• Combining qSOFA with physician judgment did not improve predictive performance over physician judgment alone (AUC 0.79).

Conclusions:

• In infected ED patients, qSOFA does not outperform unstructured physician judgment for predicting 28-day in-hospital mortality.
• qSOFA did not add value when combined with physician judgment for mortality prediction in this cohort.