qSOFA Score Calculator

Our qSOFA score calculator will help you identify high mortality risk in a patient with an infection (outside the ICU – intensive care unit) using the qSOFA criteria system. In the text below, you will learn the sepsis definition and the study in which the quickSOFA tool was originally presented. Furthermore, we will guide you through all of the qSOFA criteria and show you how to use them in our qSOFA calculator.

According to the Third International Consensus Definitions for Sepsis and Septic Shock, sepsis definition currently is "A life-threatening organ dysfunction due to a dysregulated host response to infection." We use the word "currently" because the sepsis definition has been regularly changed in recent years.

During severe infections, pathogenic microorganisms release many reactive endotoxins inside our body. In turn, our body defends itself by producing various chemical components of the inflammatory reaction (cytokines, chemokines, eicosanoids, etc.). These substances affect the walls of blood vessels and the heart, causing the walls of vessels to dilate.

Furthermore, they increase their permeability. Because of this, blood has a lower volume (as some serum escapes the vessels) and has to fulfill a larger volume of vessels. The inability to do that creates hypotension (low blood pressure). This deterioration is made worse by the lack of contractibility of the heart.

The perfusion of organs is less effective during hypotension. Organs receive a lowered supply of oxygen and start to produce energy through anaerobic metabolism. This process leads to progressive acidosis. Other pathologies that may result from sepsis include acute respiratory distress syndrome (ARDS), acute renal failure, altered consciousness, obstruction and bleeding from the gastrointestinal tract, acute liver failure, and many others.

The quickSOFA (qSOFA) score assessment tool was created by Dr. Christopher Seymour during a study with 148,907 participants – the “Assessment of Clinical Criteria for Sepsis For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)”. It is intended to be used to identify patients with a high mortality risk due to infection outside the intensive care units (ICUs). The scoring can be performed quickly at the patient's bed as it uses only clinical parameters.

A positive result of the quickSOFA score assessment (2 or more points) is associated with a 3- to 14-fold increase in the rate of hospital mortality across the entire range of baseline risks compared to those with 1 or fewer qSOFA points.

It is worth noting that the qSOFA score itself should not be used in sepsis diagnosis. It is only an indicator of whether you should perform further tests.

The quickSOFA assessment tool consists of three criteria:

1. Altered mental status – defined as a score lower than 15 in the Glasgow Coma Scale, another clinical tool created to objectively measure the state of patients' consciousness. A clinician assesses the patient's verbal, motor, and ocular reactions to stimuli. Then, he sums the points from each category. The patient can score a maximum of 15 points. It means that he is fully conscious. Every other result suggests that his mental state may be altered.

2. Fast respiratory rate – taking more than or exactly 22 breaths during each minute.

3. Low blood pressure – a systolic blood pressure (SBP) of less than or exactly 100 mmHg.

The patient may score 0 or 1 point in each of the three qSOFA criteria. They get a point if the condition of a criterium is fulfilled. The patient receives three points if all of the qSOFA criteria are met. Based on their result, they are then assigned to two mortality risk groups:

• 0-1 point – low in-hospital mortality risk group; and

• 2-3 points – high in-hospital mortality risk group – with a 3- to 14-fold increase in the rate of hospital mortality across the entire range of baseline risk compared to those with 1 or fewer qSOFA points.

We remind you that the quickSOFA assessment tool should be used to identify patients with high in-hospital mortality risk outside intensive care units (ICUs).

There is a similar tool that helps clinicians assess the probability of the survival of patients with trauma. You can learn more about it by visiting our revised trauma score calculator.

Here, we present instructions on how to use our qSOFA calculator:

1. Verify whether your patient should be assessed with the qSOFA criteria system. Remember that it should be used only outside ICUs. For the ICU population, the SOFA assessment tool may be a better choice (according to the study by Raith et al.) The patients assessed with qSOFA score should be at least 18 years old.

2. Check the mental status of your patient. To do that, use the Glasgow Coma Scale (GCS):

   • See if the eyes of the patient open spontaneously (3 points) or in response to voice command (2 points) or pain stimulus (1 point). If the eyes don't open at all, the patient receives 0 points in this category of GCS.

   • Assess the verbal response to your questions: correct orientation (4 points), confusion (3 points), single words (2 points), incomprehensible sounds (1 point), no response (0 points).

   • Check the motor response. See if the patient obeys commands (6 points), localizes pain stimulus (5 points), withdraws from pain source (4 points), has a decorticate posturing (3 points), has a decerebrate posturing (2 points), or doesn't respond at all (0 points).

   • Sum up all the points, and the result will be your patient's score on the Glasgow Coma Scale. You don't have to do that manually! You can use our GCS calculator instead. Then, select an appropriate description in the GCS field of our calculator.

3. Count the respiratory rate (RR) of your patient. One way to do it is to count the number of breaths your patient takes in 20 seconds and then multiply the result by 3. Choose a parameter of Respiratory rate (RR) field of our qSOFA calculator that matches your results.

4. Measure the systolic blood pressure (SBP) of your patient. You can do it manually with your stethoscope and sphygmomanometer or with an oscillometric blood pressure monitor. Select the appropriate value in the Systolic blood pressure (SBP) field of our calculator. When treating a patient with septic shock, it is critical to determine his mean arterial pressure (MAP) regularly. Visit our MAP calculator to learn more about the topic.

5. That's everything, and now our qSOFA score calculator will sum up the points and show the patient's mortality risk for you.