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Clin Exp Emerg Med > Accepted Articles
doi: https://doi.org/10.15441/ceem.23.125    [Accepted]
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, Republic of Korea
2Department of Emergency Medicine, School of medicine, Chungnam National University, Daejeon, Republic of Korea
3Department of Emergency Medicine, Sejong Chungnam National University Hospital, Sejong, Republic of Korea
Correspondence  Seung Ryu Tel: +82-42-280-6010, Fax: +82-42-280-6012, Email: rs0505@cnuh.co.kr
Received: September 6, 2023. Revised: October 22, 2023.  Accepted: November 20, 2023. Published online: January 29, 2024.
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 qSOFA score.
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).
Through multivariable analysis, the identified factors were age (A), male sex (M), SpO2 (S), and lactate levels (L). The AUROCs of ASqSOFA (for in-hospital mortality: 0.812; 95% CI: 0.789–0.835, for ICU admission: 0.794; 95% CI: 0.771–0.817), which included age and SpO2 with qSOFA, were simple and not inferior to 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 cut-off score of ASqSOFA for the outcome was 2 and the score for redistribution to a lower-level emergency department was 0.
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 may also be applicable in pre-hospital settings for febrile patient triage.
Keywords: Sequential Organ Failure Assessment Score; Triage; Prognosis; Mortality
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