qSOFA score for sepsis
Quick bedside screen for patients with infection at risk of poor outcome.
What qSOFA is for
The quick SOFA score was introduced with the Sepsis-3 definitions in 2016. In an adult with suspected infection outside intensive care, it flags those at higher risk of death or prolonged ICU stay. It needs no blood tests, so it can be done at triage or on a ward round.
The criteria (one point each)
- Respiratory rate 22 per minute or more.
- Altered mentation (any GCS below 15, or new confusion).
- Systolic blood pressure 100 mmHg or less.
Interpreting the score
- 2 or 3: high risk of poor outcome. Treat as sepsis now: oxygen to target, blood cultures, IV antibiotics within an hour, fluids, lactate and urine output monitoring. Involve your senior.
- 0 or 1: does not rule out sepsis. Keep reassessing, and use NEWS2 and your clinical judgement.
Worked example
A 60-year-old with fever and dysuria is drowsy (GCS 14), with respiratory rate 24 and BP 96/60. qSOFA = 3. Start the sepsis bundle immediately, send a lactate and catheterise to measure urine output.
Limitations and pitfalls
- qSOFA is a prognostic tool, not a diagnosis. Sepsis is defined as organ dysfunction (a rise in SOFA score of 2 or more) caused by infection.
- It is specific but not sensitive: many septic patients score 0 or 1 early on. The Surviving Sepsis Campaign 2021 advises against using qSOFA alone as a screening tool compared with SIRS, NEWS or MEWS.
- It is not for children or pregnant women, who have different normal values.
- Septic shock means needing vasopressors to keep mean arterial pressure at 65 mmHg or more, with lactate above 2 mmol/L (18 mg/dL) despite adequate fluids.
- In Pakistan, remember dengue, malaria and typhoid as causes of fever with low blood pressure; fluids and antibiotics differ for each.
See sepsis, the deteriorating patient and NEWS2, sepsis in children, blood cultures, dengue and the textbook chapter on septic shock and DIC.
Frequently asked questions
What does a qSOFA of 2 mean?
The patient with suspected infection has a higher risk of death or prolonged intensive care. Treat as sepsis immediately and involve a senior.
Does a qSOFA of 0 rule out sepsis?
No. qSOFA misses many early cases. Use NEWS2, the lactate and your clinical assessment, and reassess often.
What is the difference between qSOFA and SOFA?
qSOFA uses three bedside signs and is a quick risk flag. SOFA scores six organ systems using blood tests and is used to define sepsis-related organ dysfunction, mainly in intensive care.
Can qSOFA be used in children?
No. It was developed for adults. Children need age-specific assessment of heart rate, breathing, perfusion and behaviour.
A calculator supports, but does not replace, clinical judgement. Check results before acting on them.