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. 2022 Jun 17;11(12):3501.
doi: 10.3390/jcm11123501.

Is Prehospital Assessment of qSOFA Parameters Associated with Earlier Targeted Sepsis Therapy? A Retrospective Cohort Study

André Dankert  1 , Jochen Kraxner  1 , Philipp Breitfeld  1 , Clemens Bopp  2 , Malte Issleib  1 , Christoph Doehn  1 , Janina Bathe  1 , Linda Krause  3 , Christian Zöllner  1 , Martin Petzoldt  1
Affiliations

Is Prehospital Assessment of qSOFA Parameters Associated with Earlier Targeted Sepsis Therapy? A Retrospective Cohort Study

André Dankert et al. J Clin Med. .

Abstract

Background: This study aimed to determine whether prehospital qSOFA (quick sequential organ failure assessment) assessment was associated with a shortened 'time to antibiotics' and 'time to intravenous fluid resuscitation' compared with standard assessment.

Methods: This retrospective study included patients who were referred to our Emergency Department between 2014 and 2018 by emergency medical services, in whom sepsis was diagnosed during hospitalization. Two multivariable regression models were fitted, with and without qSOFA parameters, for 'time to antibiotics' (primary endpoint) and 'time to intravenous fluid resuscitation'.

Results: In total, 702 patients were included. Multiple linear regression analysis showed that antibiotics and intravenous fluids were initiated earlier if infections were suspected and emergency medical services involved emergency physicians. A heart rate above 90/min was associated with a shortened time to antibiotics. If qSOFA parameters were added to the models, a respiratory rate ≥ 22/min and altered mentation were independent predictors for earlier antibiotics. A systolic blood pressure ≤ 100 mmHg and altered mentation were independent predictors for earlier fluids. When qSOFA parameters were added, the explained variability of the model increased by 24% and 38%, respectively (adjusted R² 0.106 versus 0.131 for antibiotics and 0.117 versus 0.162 for fluids).

Conclusion: Prehospital assessment of qSOFA parameters was associated with a shortened time to a targeted sepsis therapy.

Keywords: anti-infective agents; emergency medicine; fluid therapy; organ dysfunction scores; sepsis; systemic inflammatory response syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow.
Figure 2
Figure 2
Frequency (%) of prehospital recorded sepsis indicators (standard assessment) and qSOFA parameters subdivided in two groups: EMS paramedics only (dark blue) and EMS with emergency physicians (light blue), p-values were calculated between both groups using Fisher’s exact tests; qSOFA parameters are highlighted in a box (right, blue grid lines).
Figure 3
Figure 3
Time to antibiotics. The forest plot shows the standardized coefficients with 95% CI (x-axis) and p-values for each covariable regarding the primary endpoint ‘time to antibiotics’ of two multiple linear regression models: model without qSOFA (orange ᵒ dot) and model with additional qSOFA parameters (blue • dot); time is logarithmized; the vertical solid line marks a standardized coefficient of zero, a shift to the right indicates a prolonged and to the left side a shortened ‘time to antibiotics’; qSOFA: quick sequential organ failure assessment.
Figure 4
Figure 4
Time to fluid resuscitation. The forest plot shows the standardized coefficients with 95% CI (x-axis) and p-values for each covariable regarding the secondary endpoint ‘time to fluid resuscitation’ of two multiple linear regression models (n = 702 cases): model without qSOFA (orange ᵒ dot) and model with additional qSOFA parameters (blue • dot); time is logarithmized; the vertical solid line marks a standard coefficient of zero, a shift to the right indicates a prolonged and to the left side a shortened ‘time to fluid resuscitation’; qSOFA: quick sequential organ failure assessment.
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