• Ian Ward A Maia, Oliveira J E SilvaLucasLDepartment of Emergency Medicine, Mayo Clinic, Rochester, MN, USA., Henrique Herpich, Luciano Diogo, Batista SantanaJoão CarlosJCDepartment of Emergency Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Emergency and Acute Care Medicine Research Group, Hospital de Clínicas de Porto alegre, Porto Alegre, RS, Brazil., Daniel Pedrollo, Mario Castro Alvarez Perez, and Rafael Nicolaidis.
• Department of Emergency Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Emergency Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil; Emergency and Acute Care Medicine Research Group, Hospital de Clínicas de Porto alegre, Porto Alegre, RS, Brazil. Electronic address: imaia83@hotmail.com.
• Am J Emerg Med. 2021 Dec 1; 50: 41-45.

ObjectiveTo evaluate the prognostic accuracy of qSOFA for predicting in-hospital mortality among patients with suspected infection presenting to the ED of a public tertiary hospital in Brazil.MethodsWe performed a retrospective cohort study of consecutive adult patients (age ≥ 18 years) with suspected infection who presented to an academic tertiary ED in Porto Alegre (Southern Brazil) during an 18-month period. The qSOFA was calculated by using information collected at triage and patients were followed throughout hospitalization for the primary outcome of in-hospital mortality. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios with corresponding 95% CIs were calculated for the qSOFA and qSOFA65.ResultsA total of 7523 ED visits of patients with suspected infection in which an intravenous antibiotic was administered within 24 h were included, which resulted in 908 in-hospital deaths (12.1%). There were 690 (9.2%) patients whose triage qSOFA was ≥2 points. When such cutoff was used, the sensitivity for in-hospital death was 24.6% (95% CI 21.8 to 27.4%) and the specificity was 92.9% (95% CI 92.3% to 93.5%). The sensitivity increased to 67.4% (95% CI 64.2% to 70.3%) when a cutoff of ≥1 was tested, but the specificity decreased to 55.3% (95% CI 54.1% to 56.5%). Using a cutoff of ≥2, the qSOFA65 had a sensitivity of 51.0% (95% CI 47.7% to 54.3%) and a specificity of 75.7% (95% CI 74.6% to 76.7%).ConclusionsThe qSOFA score yielded very low sensitivity in predicting in-hospital mortality. Emergency physicians or ED triage nurses in low-to-middle income countries should not be using qSOFA or qSOFA65 as "rule-out" screening tools in the initial evaluation of patients with suspected infection.Copyright © 2021 Elsevier Inc. All rights reserved.

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