Improving Sepsis Care with Risk Stratification
Sepsis is a clinically complex condition which requires early and appropriate treatment. In order to judiciously treat patients at high risk for sepsis, those patients must first be identified. One such risk stratification method being used is the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA). The purpose of this tool is to identify patients with a suspected infection that could put them at greater risk for poorer outcomes. More precisely, it is used to predict in-hospital mortality in patients with a suspected infection on general care units. The qSOFA allots one point for:
- Systolic blood pressure less than or equal to 100mm Hg
- Respiratory rate greater than or equal to 22 breaths/min
- Altered mentation, a Glasgow Coma scale score of less than 15 (GCSS < 15)
A positive score, greater or equal to 2, suggests a more thorough assessment of the patient for suspected organ failure is necessary. While useful, the criteria used in the qSOFA can also be found in patients with inflammation, ischemia and following trauma. For this reason, it has the potential to misidentify at-risk patients.
A study carried out at a large general hospital in the United Kingdom compares a screening tool known as the National Early Warning Score (NEWS), which has been shown to perform well within various clinical settings and is a frontline risk tool in many different countries, with the qSOFA The NEWS score system, rather than focusing on three variables, awards a score of 0-3 points for each of seven clinical variables:
- Respiration rate
- Peripheral capillary oxygen saturation
- The use of supplemental oxygen
- Systolic blood pressure
- Heart/pulse rate
- Level of consciousness using the AVPU (Alert, responds to Voice, responds to Pain, Unresponsive) scale
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