qSOFA (Sepse)

qSOFA: rapid sepsis screening outside the ICU

The qSOFA (quick Sequential Organ Failure Assessment) is a bedside screening tool for sepsis when you suspect infection in a patient outside the ICU. There are three criteria, worth 1 point each: a respiratory rate of ≥22/min, altered mental status (Glasgow <15), and a systolic blood pressure of ≤100 mmHg. Score ≥2 positive criteria and the patient is at high risk of in-hospital death and a prolonged ICU stay (Surviving Sepsis Campaign 2016; Sepsis-3). Example: a febrile patient with RR 24 (1) and SBP 95 (1) lands at 2 points, so you activate the sepsis bundle. The full SOFA (PaO₂/FiO₂, platelets, bilirubin, MAP, creatinine, Glasgow) stays reserved for the ICU.

Clinical context

You'll see it used in emergency triage, on the wards, and in pre-hospital care. A positive qSOFA kicks off the 1-hour bundle: blood cultures, serum lactate, broad-spectrum antibiotics, IV fluids (30 mL/kg when there's hypotension or a lactate ≥4), and vasopressors if MAP stays <65 after volume. Through 2024–2026 the argument over its sensitivity hasn't gone away. The score is highly specific but tends to miss patients who present early, which is why NEWS2 and SIRS are still worth running alongside it. Biomarkers like procalcitonin, lactate, and CRP can sharpen the call, yet no score on its own takes the place of going back and reassessing the patient.

FAQ

Does qSOFA diagnose sepsis? No. It's a screening tool that flags high mortality risk. A diagnosis needs suspected infection plus organ dysfunction, which is where the full SOFA comes in.

Can qSOFA be used in the ICU? For ICU patients the Surviving Sepsis Campaign points to the full SOFA. qSOFA was built for screening outside intensive care.

What if qSOFA is 0 or 1? A low score doesn't rule sepsis out. Keep your suspicion high, particularly in older, immunosuppressed, and pregnant patients, who often don't show the textbook signs.

Should I wait for lab results to start antibiotics? No. Once cultures are drawn, the 1-hour bundle calls for empirical antibiotics. Every hour you wait pushes mortality higher.