| Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients |
| Dong-Young Lee1, Seung Ryu1, So-Young Jeon1, Jung-Soo Park2, Yeon-Ho You1, Won-Joon Jeong1, Yong-Chul Cho1, Hong-Joon Ahn1, Chang-Shin Kang2, Se-Kwang Oh3 |
1Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
2Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
3Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Korea |
| Correspondence
Seung Ryu Tel: +82-42-280-6010, Fax: +82-42-280-6012, Email: rs0505@cnuh.co.kr |
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Received: September 6, 2023. Revised: October 22, 2023. Accepted: November 20, 2023. Published online: January 29, 2024. |
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| ABSTRACT |
Objective
Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score.
Methods
We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC).
Results
Through multivariable analysis, the identified factors were age (“A” factor), male sex (“M” factor), oxygen saturation measured by pulse oximetry (SpO2; “S” factor), and lactate level (“L” factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789–0.835]; ICU admission: 0.794 [95% confidence interval, 0.771–0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0.
Conclusion
We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage. |
| Keywords:
Sequential Organ Failure Assessment Score; Triage; Prognosis; Mortality |
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