Comparative study on quick sequential organ failure assessment, systemic inflammatory response syndrome and the shock index in prehospital emergency patients: single-site retrospective study

Aim The quick sequential organ failure assessment (qSOFA) score, shock index (SI), and systemic inflammatory response syndrome (SIRS) criteria are simple indicators for the mortality of patients in the emergency department (ED). These simple indicators using only vital signs might be more useful in prehospital care than in the ED due to their quick calculation. However, these indicators have not been compared in prehospital settings. The aim of the present study is to compare these indicators measured in prehospital care and verify whether the qSOFA score is useful for prehospital triage. Methods We undertook a single-site retrospective study on patients transferred by ambulance to the Kumamoto Medical Center ED (Kumamoto, Japan) between January 2015 and December 2016. We compared areas under the receiver operating characteristic (AUROC) curves of the qSOFA score, SI, and SIRS criteria measured in prehospital care. We also carried out sensitivity and specificity analyses using the Youden index. Results A total of 4,827 patients were included in the present study. The AUROC (95% confidence interval) of the qSOFA score for in-hospital mortality was 0.64 (0.61-0.67), which was significantly higher than those of the SIRS criteria (0.59 [0.56-0.62]) and SI (0.58 [0.54-0.62]). According to the optimal cut-off values (qSOFA >= 2) decided on as the Youden index, the sensitivity of the qSOFA score was 52.3% and its specificity was 69.9%. Conclusions The qSOFA score had the highest AUROC among three indicators. However, it might not be practical in actual prehospital triage due to its low sensitivity.