This study prospectively validated the quick Sequential Organ Failure Assessment (qSOFA) score against the Systemic Inflammatory Response Syndrome (SIRS) criteria for predicting in-hospital mortality in patients with suspected infection visiting 39 emergency departments in Japan. The qSOFA score (area under the receiver operating characteristic curve difference of +0.13, 95% confidence interval [+0.07, +0.18]) and net reclassification improvement (+0.39, 95% confidence interval [+0.15, +0.57]) more accurately predicted mortality than SIRS criteria. However, the qSOFA score alone was insufficient to predict sepsis mortality.

1. A Prospective and External Validation of Quick Sequential
Organ Failure Assessment versus Systemic Inflammatory
Response Syndrome Criteria in Patients Visiting the
Emergency Department with Suspected Infection
A. Shiraishi1, S. Gando2, S. Kushimoto3, T. Abe4,5, T. Mayumi6, H. Ogura7, D.
Saitoh8, Japanese Association for Acute Medicine (JAAM) Sepsis
Prognostication in Intensive Care Unit and Emergency Room (SPICE)
Study Group
1. Kameda Medical Center, Japan
2. Hokkaido University Graduate School of Medicine, Japan
3. Tohoku University Graduate School of Medicine, Japan
4. Juntendo University, Japan
5. Tsukuba University, Japan
6. University of Occupational and EnvironmentalHealth, Japan
7. Osaka University Graduate School of Medicine, Japan
8. National Defense Medical College, Japan

2. INTRODUCTION
The quick Sequential Organ Failure Assessment (qSOFA)
has been proposed for prediction of mortality in patients with
suspected infection outside the intensive care unit.
OBJECTIVES
To test the hypothesis that the qSOFA can more accurately
predict in-hospital mortality than systemic inflammatory
response syndrome (SIRS) criteria in patients with suspected
infection in emergency department.

3. Study design
Prospective prognostic study at 39 emergency departments in Japan.
Selection criteria
ER patients with suspected infection
Hospitalized or died in ER
Undergoing at least one of the following:
Antibiotics, cultivation or imaging
Analyses
qSOFA versus SIRS criteria (external validation)
Hospital mortality as the study outcome
Multiple imputation for missing data
ROC analysis and reclassification improvement analysis
Prespecified sample size = 900 to 2000 (adaptive design)

5. Primary comparison
AUROC difference
+0.13, 95%CI [+0.07, +0.18]
Secondary comparison
Net reclassification improvement
+0.39, 95%CI [+0.15, +0.57]

6. qSOFA was the better but insufficient to
predict sepsis mortality.