qSOFA, Cue Confusion
Authors: Mervyn Singer, Manu Shankar-Hari
Journal: Annals of Internal Medicine (2018)

Editorials20 February 2018qSOFA, Cue ConfusionMervyn Singer, MD and Manu Shankar-Hari, MDMervyn Singer, MDUniversity College London, London, United Kingdom (M.S.) and Manu Shankar-Hari, MDGuy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom (M.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3415 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In February 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force provided new definitions and clinical criteria for sepsis and septic shock (1). The systemic inflammatory response syndrome (SIRS) criteria were excluded from these new definitions because the prior focus on systemic inflammation was recognized to be an outdated paradigm. A "dysregulated host response to infection leading to organ dysfunction" (1) better suits our current knowledge base in defining sepsis, with clinical criteria of organ dysfunction (the Sequential Organ Failure Assessment [SOFA] score) being used for operational purposes. The task force stressed that the individual ...References1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10. [PMID: 26903338] doi:10.1001/jama.2016.0287 CrossrefMedlineGoogle Scholar2. Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP. Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients. Am J Respir Crit Care Med. 2015;192:958-64. [PMID: 26158402] doi:10.1164/rccm.201502-0275OC CrossrefMedlineGoogle Scholar3. Bhattacharjee P, Edelson DP, Churpek MM. Identifying patients with sepsis on the hospital wards. Chest. 2017;151:898-907. [PMID: 27374948] doi:10.1016/j.chest.2016.06.020 CrossrefMedlineGoogle Scholar4. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:762-74. [PMID: 26903335] doi:10.1001/jama.2016.0288 CrossrefMedlineGoogle Scholar5. Lee A, Bishop G, Hillman KM, Daffurn K. The Medical Emergency Team. Anaesth Intensive Care. 1995;23:183-6. [PMID: 7793590] CrossrefMedlineGoogle Scholar6. Duckitt RW, Buxton-Thomas R, Walker J, Cheek E, Bewick V, Venn R, et al. Worthing physiological scoring system: derivation and validation of a physiological early-warning system for medical admissions. An observational, population-based single-centre study. Br J Anaesth. 2007;98:769-74. [PMID: 17470844] CrossrefMedlineGoogle Scholar7. Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, et al. Quick Sepsis-related Organ Failure Assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit. Am J Respir Crit Care Med. 2017;195:906-911. [PMID: 27649072] doi:10.1164/rccm.201604-0854OC CrossrefMedlineGoogle Scholar8. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, et al. Prognostic accuracy of the quick Sequential Organ Failure Assessment for mortality in patients with suspected infection. A systematic review and meta-analysis. Ann Intern Med. 2018;168:266-75. doi:10.7326/M17-2820 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University College London, London, United Kingdom (M.S.)Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom (M.S.)Disclaimer: This editorial represents the views of the authors and does not represent the views of the U.K. Department of Health.Grant Support: Dr Shankar-Hari is supported by the National Institute for Health Research Clinician Scientist Award (NIHR-CS-2016-16-011).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3415.Corresponding Author: Mervyn Singer, MD, Bloomsbury Institute of Intensive Care Medicine, University College London, Gower Street, London WC1E 6BT, United Kingdom; e-mail, m.[email protected]ac.uk.Current Author Addresses: Dr. Singer: Bloomsbury Institute of Intensive Care Medicine, University College London, Gower Street, London WC1E 6BT, United Kingdom.Dr. Shankar-Hari: Guy's and St. Thomas' Hospitals NHS Trust, ICU Offices, Westminster Bridge Road, London SE1 7EH, United Kingdom.�This article was published at Annals.org on 6 February 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection Shannon M. Fernando , Alexandre Tran , Monica Taljaard , Wei Cheng , Bram Rochwerg , Andrew J.E. Seely , and Jeffrey J. Perry Annals On Call - Diagnosing Sepsis: Untangling Confusion Around qSOFA and SIRS Robert M. Centor and Rachael A. Lee Metrics Cited bySensitivity and specificity of a quick sequential [Sepsis‐Related] organ failure assessment sepsis screening toolIntensive Care Unit Scoring SystemsA boosting inspired personalized threshold method for sepsis screeningThe initial resuscitation of septic shockGoodbye SIRS? Innate, trained and adaptive immunity and pathogenesis of organ dysfunctionqSOFA is a useful prognostic factor for 30-day mortality in infected patients fulfilling the SIRS criteria for sepsisClinical Scores and Formal Triage for Screening of Sepsis and Adverse Outcomes on Arrival in an Emergency Department All-Comer CohortAccuracy of Quick Sequential Organ Failure Assessment Score to Predict Sepsis Mortality in 121 Studies Including 1,716,017 IndividualsEpidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and SepsisUsefulness of qSOFA and ECOG Scores for Predicting Hospital Mortality in Postsurgical Cancer Patients without InfectionIdentifying Patients at Risk for Sepsis 20 February 2018Volume 168, Issue 4Page: 293-295KeywordsHematologic testsLaboratory testsQuick sequential organ failure assessmentRespiratory rateSepsisSequential organ failure assessmentShockSpecificitySystemic inflammatory response syndromeUpper respiratory tract infections ePublished: 6 February 2018 Issue Published: 20 February 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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