Two Standards of Sepsis Care – The Nighttime Effect


  • Quick Sequential Organ Failure Assessment (qSOFA) has not provided the high predictive performance initially proposed.
  • Modifications to qSOFA has been investigated as a way to improve performance, especially in the Emergency Department (ED).
  • These simple modifications improve qSOFA, but greater analysis is needed to demonstrate superior improvements.


  • The Third International Consensus Conference on Sepsis introduced the concept of the qSOFA for the diagnosis of sepsis and screening of patients at higher risk of death.
  • qSOFA consists of 3 parameters: Respiratory Rate; Systolic Blood Pressure and Mental status.
  • qSOFA’s greatest value maybe in the assessment of sepsis related mortality in the ED.
  • Early data indicated qSOFA has better predictive capabilities than systemic inflammatory response syndrome (SIRS).
  • However, recent studies have reported poor performance of qSOFA in predicting sepsis mortality.


  • The gap between day vs night patient 3-hour bundle completion widened over the study period.
  • A positive qSOFA score still remains at 2 or more with the addition of one of these parameters.
  • The modifications to qSOFA resulted in a better AUROC in hospital mortality than qSOFA alone
  • Performance was similar between all the modified qSOFA models


  • Adding a simple currently available parameter to the qSOFA score improves sensitivity
  • Performance of any of the modifications are similar to each other and improved over qSOFA alone
  • The true value of these modifications will depend on more detailed assessments of discrimination and calibration which is currently lacking.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.