Prehospital quick sequential organ failure assessment as a tool to predict in-hospital mortality

Research paper by Kyohei Miyamoto, Naoaki Shibata; Tsuyoshi Nakashima; Seiya Kato

Indexed on: 03 Mar '18Published on: 14 Feb '18Published in: American Journal of Emergency Medicine


Publication date: Available online 10 February 2018 Source:The American Journal of Emergency Medicine Author(s): Kyohei Miyamoto, Naoaki Shibata, Tsuyoshi Nakashima, Seiya Kato Objective This study aimed to evaluate the predictive ability of quick sequential organ failure assessment (qSOFA) score for in-hospital mortality among patients transported by physician-staffed helicopters. Methods We conducted a single-center, retrospective observational study using the physician-staffed helicopter registry data between 2003 and 2016. We calculated the qSOFA scores based on the patients' vital signs, which were measured on the scene. The tool's discriminatory ability was determined using the area under the curve of the receiver operating characteristic. Results A total of 1849 patients with a mean age of 63.0 (standard deviation [SD], 18.4) years were included in this study. The diagnostic categories included were trauma and nontrauma cases (1038 [56%] and 811 [44%], respectively). In-hospital mortality was documented in 169 (9%) patients. Meanwhile, the in-hospital mortality rates among patients with qSOFA scores of 0, 1, 2, and 3 were 5/411 (1%), 69/797 (9%), 71/541 (13%), and 24/100 (24%), respectively (P < 0.0001 for trend). If the cutoff point is ≥1, the sensitivity and specificity of the qSOFA scores were 0.97 and 0.24, respectively. The area under the curve of the qSOFA scores was 0.67 for all patients, whereas that for trauma patients was 0.75. Conclusion An increase in the qSOFA score is associated with a gradual increase in the in-hospital mortality rate among all patients. In particular, a very low mortality rate was observed among patients with a qSOFA score of 0. The qSOFA score predicted the in-hospital mortality of patients with trauma well.