qSOFA vs. SIRS

One tool that has been used for years in the identification of sepsis is ‘SIRS’.  SIRS is defined as, ‘Systematic Inflammatory Response Syndrome’.  SIRS Criteria was created to define a clinical response to an infection or noninfectious origin.  SIRS Criteria guidelines were used to help identify possible sepsis. 

            The problem though, “sepsis is now recognized to involve early activation of both pro- and anti- inflammatory responses and it is this that makes it difficult to use SIRS Criteria.  Also, SIRS criteria (Heart rate, body temperature, respiratory rate, white blood cell count) can be present in patients that will have no infection present at all, thus the use of SIRS Criteria should be limited (Angus & Singer, 2016).

qSOFA SCALE

            SOFA (Sequential Organ Failure Assessment) score has been widely used to track a patient’s health while hospitalized in intensive care units.  SOFA is merely a scoring system that when used, will determine how severe a patient will be and what the patient’s extent of organ failure and damage they may have. SOFA is not used to manage a patient while they are hospitalized but rather to clinically characterize the patient as a whole. 

            While SOFA is used for hospitalized patients, qSOFA has been created to characterize the patient in the field. 

            qSOFA (quick Sequential Organ Failure Assessment) was introduced by the Consensus Group in February 2016.  It is now recommended that SIRS and MODS criteria no longer be used, but rather implement a much simpler and quick assessment tool called qSOFA.

            To formulate a score from qSOFA one must score positive for the following 3 criteria after it has been determined the patient has or possibly has an infection:

·         New/Worsened Altered Mentation

·         Respiratory Rate Greater than 22

·         Systolic BP Less or Equal to 100

            If the patient has a positive qSOFA score then field personnel must implement critical and urgent care for the patient utilizing rapid fluid challenge and the implementation of vasopressors if necessary.