qSOFA
Bedside alert for poor outcome in suspected infection
- Sepsis-3 (SCCM/ESICM 2016)
Sources last checked: 2026-10-13
qSOFA
Bedside alert for poor outcome in suspected infection
Does not rule out sepsis; qSOFA can change as the clinical course evolves.
A prognostic prompt, not a diagnosis of sepsis. The Surviving Sepsis Campaign 2021 recommends against using qSOFA alone as a screening tool (it is specific but insensitive).
Interpretation
| 0–1 — not flagged | Does not rule out sepsis; qSOFA can change as the clinical course evolves. |
|---|---|
| ≥ 2 — flagged | Higher risk of death or ICU stay ≥ 3 days. Sepsis-3 describes a positive qSOFA as a prompt to look for organ dysfunction (SOFA). |
What is the qSOFA?
qSOFA (quick SOFA) is a three-item bedside score — respiratory rate ≥ 22/min, altered mentation, systolic blood pressure ≤ 100 mmHg — introduced with the Sepsis-3 definitions in 2016. Seymour and colleagues derived it from over 148,000 encounters with suspected infection; two or more points identified patients at higher risk of death or prolonged ICU stay. It is a prognostic prompt, not a diagnostic criterion for sepsis.
When to use it
- Adults with suspected infection outside the ICU, as a quick prompt to look for organ dysfunction.
- To flag patients with two or more criteria, in whom Sepsis-3 describes a further search for organ dysfunction (SOFA).
- As part of a broader assessment alongside NEWS2, lactate and clinical judgement.
When not to use it
- As the only screening tool for sepsis — the Surviving Sepsis Campaign 2021 recommends against this (strong recommendation).
- To rule out sepsis: a score of 0–1 does not exclude it.
- In the ICU, where the full SOFA score defines organ dysfunction.
How it is calculated
| Criterion | Points |
|---|---|
| Respiratory rate ≥ 22/min | +1 |
| Altered mental status (GCS < 15) | +1 |
| Systolic blood pressure ≤ 100 mmHg | +1 |
Clinical pearls and limitations
- A prognostic prompt, not a diagnosis of sepsis. The Surviving Sepsis Campaign 2021 recommends against using qSOFA alone as a screening tool (it is specific but insensitive).
- Sepsis-3 defines sepsis as an acute increase in SOFA of ≥ 2 points due to infection; qSOFA only predicts poor outcome.
- qSOFA is more specific but less sensitive than SIRS; early in the course many patients who go on to deteriorate score 0–1.
- In UK and many European hospitals NEWS2 is the standard track-and-trigger tool; qSOFA can complement it.
- Altered mentation means any GCS below 15 — subtle confusion counts.
Frequently asked questions
Is qSOFA still recommended?
It remains part of the Sepsis-3 framework as a prognostic marker, but the Surviving Sepsis Campaign 2021 recommends against using it alone to screen for sepsis compared with SIRS, NEWS or MEWS.
qSOFA vs SIRS — what is the difference?
SIRS (temperature, heart rate, respiratory rate, white cell count) is sensitive but non-specific for infection. qSOFA uses three clinical signs to flag patients at risk of a poor outcome; it is more specific and less sensitive.
Does a qSOFA of 2 mean the patient has sepsis?
No. It means a higher risk of death or ICU stay of three days or more. Sepsis requires infection plus organ dysfunction (SOFA increase ≥ 2).
Evidence and guidelines
- Primary source: Singer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315(8):801-810.
- Seymour CW et al. Assessment of clinical criteria for sepsis (qSOFA derivation and validation). JAMA 2016;315(8):762-774.
- Evans L et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181-1247 — recommends against qSOFA as a single screening tool.
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