نظرة سريرية عامة

The quick Sequential Organ Failure Assessment (qSOFA) is a three-variable bedside prompt developed to identify adults with suspected infection who may have a greater risk of death or prolonged intensive care. It uses only respiratory rate, systolic blood pressure, and mental status, allowing calculation without laboratory tests. qSOFA is best understood as a severity signal: it is not a definition of sepsis and it does not establish the presence or source of infection.

A score of two or three should trigger timely reassessment for organ dysfunction, review of perfusion and oxygenation, and consideration of escalation. Clinicians should integrate the score with the full examination, trends in observations, comorbidity, frailty, lactate, urine output, and local sepsis pathways. A low score must never be used to reassure against clear clinical deterioration.

دواعي الاستخدام

• Adults with known or suspected infection outside the ICU
• Rapid screening when organ dysfunction is a concern
• Repeated assessment during clinical deterioration

القيود والسلامة

Use qSOFA primarily in adults with possible infection, particularly outside an ICU. Its specificity for adverse outcome is generally better than its sensitivity, so patients with serious infection may score zero or one. Early disease, supplemental oxygen, analgesia, pregnancy, autonomic dysfunction, antihypertensive treatment, and chronic neurologic impairment can all change the measured variables without faithfully representing acute infection severity.

Record the actual values and time, not only the total. Recalculate after interventions because trends are clinically meaningful. In children use an age-appropriate pediatric sepsis pathway rather than adult qSOFA. In any patient with shock, hypoxemia, mottling, oliguria, rapidly changing consciousness, or clinician concern, start stabilization and senior review irrespective of score.

• Not validated as a stand-alone sepsis diagnostic test
• Do not delay resuscitation, lactate measurement, cultures, or antibiotics
• Use caution when baseline cognition, respiratory rate, or blood pressure is chronically abnormal

المعادلة

qSOFA = 1 point each for respiratory rate ≥ 22/min + systolic blood pressure ≤ 100 mmHg + altered mentation (GCS < 15)

تفسير النتائج

• 0–1 — Lower risk signal: Adverse outcome remains possible; sensitivity is limited. Continue clinical evaluation, obtain indicated investigations, and repeat observations.
• 2–3 — Higher risk signal: Associated with increased in-hospital mortality or prolonged ICU stay. Urgent organ-dysfunction assessment, closer monitoring, and escalation per sepsis protocol.

المراجع

1. Singer M, et al. Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016.
2. Seymour CW, et al. Assessment of Clinical Criteria for Sepsis. JAMA. 2016.
3. Surviving Sepsis Campaign international guidelines 2021.

الأسئلة الشائعة

Does qSOFA diagnose sepsis?

No. It is a prognostic bedside prompt in suspected infection. Sepsis requires clinical recognition of life-threatening organ dysfunction caused by a dysregulated response to infection.

Should antibiotics wait until qSOFA reaches 2?

No. Antimicrobial and source-control decisions depend on the complete presentation and local protocol. A low score must not delay treatment when sepsis or septic shock is suspected.

Can qSOFA be used in children or pregnancy?

Adult qSOFA is not an appropriate substitute for validated pediatric or obstetric assessment pathways. Use population-specific early warning and sepsis guidance.