Prognostic value of triage quick SOFA score on emergency service patient who have fever; An observational study

Backround: There is no gold standard test or score to be used in the diagnosis or termination of sepsis. The aim of this study is to demonstrate the value of qSOFA score which is recommended for using in emergency services in the final guideline, by the triage staff in the triage field, and also by the emergency care physicians, in determining the prognosis of the patient and to compare these scoring with other known scoring systems. Methods: This observational, analytical study was applied to 818 patients who referred to the emergency room triage area, in Akdeniz University Faculty of Medicine, Department of Emergency Service, between 15 May 2017 – 15 September 2017. Patients with fever > 37.5 C in infrared body temperature measurements were included in the study. 47 patients who were under the age of 18, pregnant, refused treatment and leaved hospital without permission and multiple referrals to the hospital were removed from study. The effects of qSOFA, SIRS and dichotomized triage categories on all hospitalization, intensive care hospitalization, 1st week mortality and 1st month mortality in 771 patients were evaluated. Results: Of the 771 patients, 426 (55.3%) were male and 345 (44.7%) were female. Triage categories of the patients were; category 1 in 2 patients (0.3%), category 2 in 91 patients (11.8%), category 3 in 407 patients (52.8%), category 4 in 259 patients (33.6%) and category 5 in 12 patients (1.6%). Patients with triage 1 – 2 - 3 in dichotomized triage were considered positive (500 patients) and those with triage 4 - 5 were negative (271 patients). 723 (93.8%) of 771 patients had negative qSOFA, 48 (6.2%) had positive qSOFA; SIRS value of 269 patients (34.9%) was negative and SIRS value of 502 patients (65.1%) was positive. 595 (77.2%) of 771 patients were discharged from hospital, 175 (22.7%) were hospitalized and 1 (0.1%) died in the emergency department. 34 (4.4%) patients were hospitalized in intensive care unit. 763 patients (99%) had negative 1st week mortality and 8 (1%) had positive 1st week mortality. 744 patients (96.5%) had negative 1st month mortality and 27 (3.5%) had positive 1st month mortality. Conclusion: We found that qSOFA is not required to be used as a screening test in triage area, dichotomized triage data is as effective as qSOFA and SIRS in determining all hospitalization and mortality, qSOFA can be used for predicting mortality in patients with high-risk of sepsis, SIRS is still a criteria for excluding sepsis in patients with low risk of sepsis in emergency departments.