Re: Should prehospital early warning scores be used to identify which patients need urgent treatment for sepsis? Can qSOFASIO2 be an option?
Steve Goodacre et. al. (https://www.bmj.com/content/375/bmj.n2432) analyze the limitations of scores to identify patients with sepsis, including NEWS2.
Other scores, like qSOFA (https://doi.org/10.1016/j.ajem.2021.06.079Get rights and content), EPIC Sepsis Model (Wong A et al. JAMA Intern Med 2021 Aug) and Medicare's SEP-1(Barbash IJ et al. Ann Intern Med 2021 Apr 20) have also shown limitations.
The Shock Index, a simple calculation dividing the heart rate over systolic blood pressure has been used for decades in emergencies, and more recently has demonstrated its utlility in cardiac emergencies (https://doi.org/10.1093/ehjacc/zuab050) and sepsis (10.1016/j.ajem.2019.11.004
), including covid (DOI: 10.1017/dmp.2021.187) .
The Shock Index can be sensitive enough (more than blood pressure alone) to identify the high risk patients with sepsis, and more so in combination with other parameters like in qSOFA, utilizing the shock index instead of blood pressure alone, and adding SpO2, besides the respiratory rate.
I propose then to investigate the usefulness of the modified qSOFASIO2.
Keeping the concept of qSOFA with 2 parameters positive, that could include one point for shock index (SI), positive if 0.9 or more, and one point for SpO2 92% or less, beside the usual parameters of qSOFA.
I hope it can be an advance in the early identification of patients with sepsis.
Prof. Enrique Sanchez Delgado, MD
Internal Medicine-Clinical Pharmacology and Therapeutics
Hospital Vivian Pellas, Managua, Nicaragua
Competing interests: No competing interests