Short summary

There is a need for a present-day study surveying the predictive and prognostic value of the qSOFA score in large populations, across multiple etiologies, regardless of infection status. 

Descriptive cohort-study in the ED at Odense University Hospital (OUH)  covering a three-year period from April 1st 2012 - 31th March 2015.

Evidence of the qSOFA scores eligibility as a means of predicting prognosis, regardless of etiology will promote its use earlier in the care for the acute patient. Hence promote the initiation of relevant treatment at the right time.

Rationale

Early recognition and subsequent diagnosis and treatment of the critically ill patient is crucial and has a big influence on mortality and morbidity. Acute patients arriving at the Emergency Department (ED) are in very different conditions and pointing out patients in critical condition is not obvious in any case. 

Sepsis continues to be a major cause of mortality and morbidity in the USA and Denmark, and has had different definitions from 1991 through 2016. The Third International Consensus Definitions for Sepsis and Septic Shock in 2016 emphasizes the presence of organ failure as a defining element of Sepsis, and the organ dysfunction is evaluated by the formerly called Sepsis-related Organ Failure Assessment (SOFA) score. Studies suggest that the predictive and prognostic value of the SOFA-score remains among patients with no detectable infection, as well as trauma patients. The SOFA-score has since been renamed the Sequential Organ Failure Assessment Score to attenuate the connection to infection. There has also been development of a quick and bedside score called quick Sequential Organ Failure Assessment score (qSOFA), which has predictive and prognostic value similar to that of the SOFA-score. However, the Third Consensus definition for Sepsis has further promoted the SOFA-Score as a sepsis adjunct. The formerly mentioned studies regarding trauma patients and non-infected patients have several limitations, age and small study populations being the major ones. Hence the need for a present-day study surveying the predictive and prognostic value of the qSOFA score in large populations, across multiple etiologies; to validate the use of qSOFA scoring as a universal tool for assessing patients in the ED, regardless of infection status. 

Objective

The aim is to describe the ability of the qSOFA score to predict 7 day mortality across etiologies in acute adult ED patients.

Description of the cohort

All adult patients, >17 years of age, in the Emergency Department at Odense University Hospital are included

Data and biological material

First vital value within 6-hours of arrival is extracted from the patients electronic records. Vital values: respiratory frequence, peripheral oxygen saturation, pulse, blood pressure, Glasgow Coma Scale and temperature. 

Furthermore data on sex, age and comorbidity is extracted.

Data regarding discharge diagnosis and indicators of ICU stay will be collected from the Danish National Patient Registry.

Information regarding date of death and migration status will be collected from the Danish Civil Registration System.

Collaborating researchers and departments

Department of Emergency Medicine, Odense University Hospital

• BSc Med. Wuttapichai Promchalee

Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark & Odense University Hospital

• Peter Bank Pedersen, MD

Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital

• Professor Søren Mikkelsen, MD, PhD

Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark & Odense University Hospital

• Professor, Consultant, Annmarie Touborg Lassen, PhD, DMSci