Calculate the quick SOFA (qSOFA) score for bedside sepsis screening. Uses 3 simple criteria to identify patients at risk for poor outcomes from infection.
The quick SOFA (qSOFA) score is a bedside clinical tool introduced as part of the Sepsis-3 consensus definitions (2016) to identify patients with suspected infection who are at increased risk for poor outcomes. Using only three criteria — systolic blood pressure ≤100 mmHg, respiratory rate ≥22, and Glasgow Coma Scale <15 — it requires no laboratory testing and can be assessed in seconds.
qSOFA ≥2 identifies patients with a 3 to 14-fold increase in in-hospital mortality compared to those with qSOFA <2. The score serves as a prompt to check for organ dysfunction (using the full SOFA score), initiate appropriate therapy, and consider ICU-level care. Importantly, qSOFA is a screening tool, not a diagnostic criterion for sepsis — the Sepsis-3 definition requires documented organ dysfunction (SOFA increase ≥2) in the setting of infection.
The simplicity of qSOFA makes it ideal for initial triage in emergency departments, hospital floors, and resource-limited settings where laboratory results may not be immediately available. It replaces the older SIRS criteria as the recommended bedside screening tool for sepsis.
The prior SIRS criteria (temperature, heart rate, respiratory rate, white blood cell count) were overly sensitive — up to 90% of ICU patients met SIRS criteria at some point, making it poorly specific for sepsis. qSOFA dramatically improves specificity while maintaining adequate sensitivity for predicting poor outcomes.
As a no-lab-required bedside tool, qSOFA enables rapid triage decisions before any blood work returns, which is critical in the golden hour of sepsis management.
qSOFA Score = Sum of: SBP ≤100 mmHg: 1 point RR ≥22/min: 1 point GCS <15: 1 point Range: 0-3 0: Low risk (<3% mortality) 1: Intermediate (~10% mortality) ≥2: High risk (24%+ mortality) — evaluate for organ dysfunction
Result: qSOFA 3/3 — High Risk
All three criteria present: SBP 90 (≤100), RR 24 (≥22), GCS 14 (<15). This patient has maximum qSOFA and should receive immediate sepsis bundle: blood cultures × 2, serum lactate, broad-spectrum antibiotics within 1 hour, and 30 mL/kg crystalloid for hypotension. ICU transfer should be arranged. Full SOFA score should be calculated.
Sepsis-3 (2016) redefined sepsis as "life-threatening organ dysfunction caused by a dysregulated host response to infection." This replaced the prior SIRS-based definition. Key elements: Sepsis = infection + SOFA ≥2. Septic shock = sepsis + vasopressor requirement for MAP ≥65 + lactate >2 despite adequate resuscitation. qSOFA serves as the screening gateway that prompts full SOFA assessment.
Every hour of antibiotic delay in septic shock is associated with approximately 7% increase in mortality. The hour-1 bundle emphasizes that cultures, antibiotics, lactate, and IV fluids should all be initiated within 60 minutes of sepsis recognition. qSOFA helps identify the clock-starting moment at the bedside.
qSOFA has been criticized for: (1) Lower sensitivity than SIRS for identifying sepsis (may miss early cases), (2) Not incorporating temperature or white count (traditional infection markers), (3) Performing poorly in some validation cohorts. Some guidelines (e.g., UK NICE) still recommend NEWS over qSOFA for sepsis screening. The 2021 Surviving Sepsis Campaign suggests using qSOFA as one tool among many, not as a standalone screening method.
qSOFA replaces SIRS as a bedside SCREENING tool, but neither qSOFA nor SIRS are diagnostic. The Sepsis-3 definition of sepsis requires: (1) suspected or confirmed infection PLUS (2) acute organ dysfunction as measured by SOFA increase ≥2. qSOFA identifies patients who should be evaluated for this organ dysfunction.
Yes. qSOFA has moderate sensitivity (~60-70%) but high specificity for predicting poor outcomes. A qSOFA <2 does NOT rule out sepsis — patients with suspected infection and qSOFA <2 may still have sepsis and should continue to be monitored. qSOFA is better at predicting mortality than at diagnosing sepsis.
The 2018 Surviving Sepsis Campaign hour-1 bundle: (1) Measure lactate, re-measure if >2 mmol/L, (2) Obtain blood cultures before antibiotics, (3) Administer broad-spectrum antibiotics, (4) Begin rapid fluid resuscitation (30 mL/kg crystalloid) for hypotension or lactate ≥4, (5) Apply vasopressors if hypotensive during or after fluid resuscitation (target MAP ≥65). Use this as a practical reminder before finalizing the result.
qSOFA uses 3 criteria without labs and was designed specifically for infection. NEWS (National Early Warning Score) and MEWS use 6-7 vital sign parameters and are designed for general clinical deterioration, not specifically sepsis. Some studies suggest NEWS may outperform qSOFA for sepsis screening on general wards because it uses more parameters.
qSOFA was validated primarily for patients outside the ICU (ED, floor, outpatient). In the ICU, the full SOFA score should be used because ICU patients often meet qSOFA criteria from baseline critical illness. The Sepsis-3 guidelines specifically recommend qSOFA for non-ICU settings.
Serum lactate ≥2 mmol/L is an important marker of tissue hypoperfusion in sepsis. However, lactate requires a blood draw and processing time. qSOFA is complementary — it provides immediate bedside assessment while lactate results are pending. Elevated lactate with qSOFA ≥2 identifies the highest-risk patients.