Prehospital quick Sequential Organ Failure Assessment for predicting prognosis in patients with sepsis or suspected sepsis: a population-based ORION registry

Abstract BackgroundIn 2016, the quick Sequential Organ Failure Assessment (qSOFA) was proposed for use as a simple screening tool for sepsis, with sepsis suspected at a score ≥ 2 points. In this study, we evaluated the effectiveness of prehospital qSOFA for predicting prognosis in patients with sepsis or suspected sepsis using the population-based Osaka Emergency Information Research Intelligent Operation Network (ORION) registry, which compiles prehospital ambulance data and in-hospital information.MethodsThe study enrolled 437,974 patients in the ORION registry from January 1 to December 31, 2016. We selected hospitalized patients with sepsis or suspected sepsis using the appropriate ICD 10 codes. We excluded the patients with i) missing data (outcome, Japan Coma Scale, respiratory rate, blood pressure), ii) respiratory rate ≥ 60/min, and iii) blood pressure ≥ 250 mmHg. These measures were evaluated by ambulance personnel when they first contacted the patient in the prehospital setting. The primary endpoint was discharge to death.ResultsIn total, 12,646 patients (median age: 78 [IQR: 65–85] years, male: n = 6760 [53.5%]) were eligible for our analysis. In a multivariable logistic regression analysis adjusted for confounding factors, the proportion of patients discharge to death was significantly higher for qSOFA positive (≥ 2 points) than negative (≤ 1 point) (265/2250 [11.78%] vs. 415/10,396 [3.99%]; adjusted odds ratio 2.909; 95% confidence interval 2.469–3.428, p < 0.0001). The specificity and sensitivity were 83.4% and 40.0%, respectively, and the area under the receiver operating characteristic curve for qSOFA positive was 0.61.ConclusionsqSOFA evaluated by emergency medical services personnel in the prehospital setting might be useful for predicting prognosis in patients with sepsis or suspected sepsis.