qSOFA fails validation

EMCrit

 Bad news for sepsis-3.0: qSOFA fails validation

PulmCrit - October 1, 2016 - By Josh Farkas

"Sepsis 3.0 replaced the SIRS criteria with a new risk-stratification tool, qSOFA. qSOFA was initially developed within the Sepsis-3 publication itself. Until now, qSOFA has never been validated. The value of qSOFA vs. SIRS remains controversial...

Summary

• Churpek et al. 2016 is the first study to attempt validation of qSOFA.
• qSOFA and SIRS have similar overall performance in predicting the combined outcome of death or ICU transfer. qSOFA has a higher specificity, but this comes as a tradeoff for lower sensitivity.
• qSOFA is <40% sensitive for detecting a patient who will die or need ICU transfer in 12 hours.
• qSOFA is consistently out-performed by the NEWS score, a more sophisticated bedside risk-stratification tool (figure below).
• This study doesn’t support the Sepsis-3 definition. Further evidence is needed before considering the widespread adoption of qSOFA and Sepsis-3. The British approach using the NEWS score appears superior."