Accurate QSOFA calculation requires precise measurement of three critical parameters and understanding of their clinical significance. Follow this systematic approach to ensure reliable risk assessment and appropriate clinical decision-making in emergency situations.
1. Respiratory Rate Assessment and Measurement
Measure respiratory rate by counting the number of breaths over one full minute, or count for 30 seconds and multiply by 2. Ensure the patient is at rest and not speaking during measurement. Respiratory rates ≥22 breaths/min indicate respiratory distress and contribute 1 point to the QSOFA score. Consider factors that may affect respiratory rate, such as pain, anxiety, fever, or underlying respiratory conditions. In mechanically ventilated patients, use the set respiratory rate for assessment.
2. Systolic Blood Pressure Measurement and Interpretation
Measure systolic blood pressure using standard techniques with appropriate cuff size and patient positioning. Systolic blood pressure ≤100 mmHg indicates hypotension and contributes 1 point to the QSOFA score. Consider the patient's baseline blood pressure, as some patients may have chronic hypertension and their 'normal' pressure may be higher. In cases of severe hypotension (<90 mmHg), immediate intervention is typically required regardless of other parameters.
3. Glasgow Coma Scale Assessment and Scoring
Assess Glasgow Coma Scale (GCS) by evaluating three components: eye opening (1-4 points), verbal response (1-5 points), and motor response (1-6 points). Total scores ≤13 indicate altered mental status and contribute 1 point to the QSOFA score. GCS assessment should be performed after correcting reversible causes of altered consciousness, such as hypoglycemia or opioid overdose. Document the individual component scores for comprehensive neurological assessment.
4. Score Calculation and Risk Stratification
Sum the points from all three parameters to calculate the total QSOFA score (0-3 points). Scores of 0-1 indicate low risk, while scores ≥2 indicate increased risk of poor outcomes and should trigger sepsis protocols. Consider the clinical context and patient history when interpreting scores, as some patients may have chronic conditions that affect baseline parameters. Use the score as part of a comprehensive clinical assessment rather than in isolation.