The presence of ≥2 variables places the patient in a high-risk category for mortality. The quick-SOFA (qSOFA) score 5 was created to risk-stratify patients without the need for blood tests and has three variables: respiratory rate (RR) ≥22/min, systolic blood pressure (SBP) ≤100 mm Hg and altered mental state. Calculation of the change in SOFA score in a busy ED is at best labour intensive, as it requires the calculation of the presenting and baseline SOFA scores, and at worst inaccurate as some of the criteria are not met or routinely measured in the ED. The objective criteria defining sepsis, a minimum two-point increase, 1 in the Sequential Organ Failure Assessment (SOFA) score, 4 corresponds to a mortality rate of over 10%. The ED is a pressured environment and any score that is used should be easy to calculate using readily available variables. Patients at high-risk of death may be identified by using an evidence based risk-stratification score.
In addition, it facilitates the initiation of a conversation on prognosis.
Identification of the high-risk patients will both facilitate increased focus of care and also helps determine the transfer destination. 3 It is therefore important to identify patients at highest risk of death in the emergency department (ED). 2 The majority of patients in hospital with sepsis are admitted as an emergency with community acquired sepsis. Sepsis, a life-threatening condition, 1 is best managed by early recognition and treatment.
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