Accurate sepsis assessment using the Sepsis-3 calculator requires systematic evaluation of multiple clinical parameters and understanding of their interrelationships. This step-by-step approach ensures reliable risk assessment and appropriate clinical decision-making in emergency and critical care settings.
1. Initial Assessment and Infection Suspicion
Begin by evaluating whether there is clinical suspicion of infection based on history, physical examination, and laboratory findings. This is the fundamental requirement for sepsis assessment. Consider sources of infection such as pneumonia, urinary tract infection, intra-abdominal infection, or bloodstream infection. Document the suspected infection source and any relevant microbiological data. The presence of suspected infection is a prerequisite for sepsis diagnosis according to Sepsis-3 criteria.
2. Respiratory System Assessment
Evaluate respiratory function using two key parameters: respiratory rate and PaO2/FiO2 ratio. Respiratory rate ≥22 breaths/min contributes to qSOFA scoring, while PaO2/FiO2 ratio <300 indicates respiratory dysfunction for SOFA scoring. In mechanically ventilated patients, use the set respiratory rate and calculate PaO2/FiO2 ratio from arterial blood gas measurements. Consider factors that may affect respiratory parameters such as underlying lung disease, pain, or anxiety.
3. Cardiovascular System Evaluation
Assess cardiovascular function through systolic blood pressure measurement and vasopressor use evaluation. Systolic blood pressure ≤100 mmHg contributes to qSOFA scoring, while more severe hypotension and vasopressor requirements are evaluated in SOFA scoring. Document the type and dose of vasopressors if used, as this is critical for distinguishing septic shock from uncomplicated sepsis. Consider the patient's baseline blood pressure when interpreting results.
4. Neurological Assessment
Evaluate neurological function using the Glasgow Coma Scale (GCS). Scores ≤13 indicate altered mental status and contribute to both qSOFA and SOFA scoring. Perform GCS assessment after correcting reversible causes of altered consciousness such as hypoglycemia, opioid overdose, or metabolic derangements. Document individual component scores (eye opening, verbal response, motor response) for comprehensive neurological assessment.
5. Laboratory Parameter Assessment
Evaluate laboratory parameters including platelet count, bilirubin, and creatinine for SOFA scoring. Platelet count <150 ×10³/μL indicates coagulation dysfunction, bilirubin >1.2 mg/dL suggests hepatic dysfunction, and creatinine >1.5 mg/dL or urine output <500 mL/24h indicates renal dysfunction. Use the most recent laboratory values and consider trends over time. Document the timing of laboratory measurements relative to clinical assessment.
6. Score Calculation and Interpretation
Calculate both SOFA and qSOFA scores using the collected parameters. SOFA scores ≥2 indicate organ dysfunction and support sepsis diagnosis, while qSOFA scores ≥2 suggest increased risk of poor outcomes. Combine scoring results with clinical judgment to determine sepsis probability and guide management decisions. Consider the patient's baseline health status and comorbidities when interpreting scores.