Quick screen for sepsis-related organ dysfunction (Sepsis-3)

What it is and when to use it

The qSOFA (quick Sepsis-related Organ Failure Assessment) is a rapid bedside tool to identify patients with suspected infection who are at higher risk of poor outcomes (in-hospital mortality or prolonged ICU stay). It assesses three simple clinical criteria with no laboratory tests required: respiratory rate, mental status, and systolic blood pressure. It was introduced by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3, 2016, JAMA), endorsed by the SCCM and ESICM, as an alerting tool outside the ICU.

How to interpret it

One point is assigned for each of the three criteria: respiratory rate ≥ 22 breaths/min, altered mental status (Glasgow Coma Scale < 15), and systolic blood pressure ≤ 100 mmHg. The score ranges from 0 to 3. A qSOFA ≥ 2 identifies patients with suspected infection at greater risk of mortality and adverse outcomes, and should prompt escalation of monitoring, assessment of organ dysfunction with the full SOFA score, and early initiation of treatment. A score of 0 or 1 does not rule out sepsis or severe infection.

Limitations and when not to use it

Validated in adult patients with suspected infection, primarily outside the ICU (emergency department and ward). It is a prognostic screening tool, not a diagnostic one: it does not define sepsis on its own and does not replace clinical judgment or the full SOFA score. It has limited sensitivity, so a low qSOFA does not exclude severe infection and must not be used to rule out sepsis or to delay treatment. The Surviving Sepsis Campaign 2021 guidelines recommend against using qSOFA as a single screening tool compared with systems such as SIRS, NEWS, or MEWS.

Frequently asked questions

What does a qSOFA score of 2 or more mean?

It indicates that a patient with suspected infection is at increased risk of in-hospital mortality and adverse outcomes. Monitoring should be escalated, organ dysfunction assessed with the full SOFA score, and early treatment started.

What is the difference between qSOFA and SOFA?

SOFA is a full six-system organ-dysfunction score requiring laboratory data, used mainly in the ICU. qSOFA is a rapid three-criteria clinical version, without lab tests, designed for bedside alerting outside the ICU.

Does a negative qSOFA rule out sepsis?

No. qSOFA has limited sensitivity; a score of 0 or 1 does not exclude severe infection or sepsis and should never be used to delay assessment or treatment when clinical suspicion is high.