The Three Criteria
1
Respiratory Rate ≥ 22/min+1 point if present
2
Altered Mentation (GCS < 15)+1 point if present
3
Systolic BP ≤ 100 mmHg+1 point if present
Maximum score = 3. No laboratory or imaging required. Can be performed at the bedside in under 60 seconds.
Interpretation
| qSOFA Score | Risk | Action |
|---|
| 0–1 | Low risk | Continue observation; review if clinical deterioration |
| ≥ 2 | High risk — sepsis likely | Perform full SOFA assessment; blood cultures × 2; lactate; IV antibiotics within 1 hour; fluid resuscitation 30 mL/kg if lactate ≥ 4 or hypotension; ICU referral |
Clinical Application
- Where to use qSOFA: Ward, ED, outpatient setting — any location outside the ICU where laboratory SOFA cannot be calculated rapidly. qSOFA is the ward equivalent of SOFA for triggering a sepsis response.
- Sepsis-3 definition: Sepsis = life-threatening organ dysfunction (SOFA ≥ 2 above baseline) due to infection. qSOFA ≥ 2 is a prompt to calculate SOFA — it is not itself diagnostic of sepsis.
- Hour-1 sepsis bundle (Surviving Sepsis Campaign 2018): Measure lactate; Blood cultures before antibiotics; Broad-spectrum antibiotics; Fluid resuscitation (30 mL/kg crystalloid for lactate ≥ 4 or hypotension); Vasopressors for MAP < 65 mmHg.
- Sensitivity vs. NEWS2: qSOFA has lower sensitivity than NEWS2 for detecting patients who deteriorate — some guidelines recommend NEWS2 as the primary sepsis alert trigger, with qSOFA used when NEWS2 threshold is met.
- Immunocompromised patients: May not mount a fever or leukocytosis. qSOFA criteria are vital sign-based and so remain applicable even in the absence of classic sepsis signs.
- A qSOFA score of 0 does not exclude sepsis — clinical suspicion must always guide workup, particularly in elderly or immunocompromised patients.
References
- Singer M, et al. (Sepsis-3). The Third International Consensus Definitions for Sepsis and Septic Shock. JAMA. 2016;315(8):801–810.
- Seymour CW, et al. Assessment of clinical criteria for sepsis. JAMA. 2016;315(8):762–774.
- Levy MM, et al. The Surviving Sepsis Campaign Bundle: 2018 Update. Crit Care Med. 2018;46(6):997–1000.