Predictive value of the quick Sequential Organ Failure Assessment Score (qSOFA) for in-hospital mortality in adult trauma patients

Document Type : Original Article


1 Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Faculty of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran


Background: Recognizing and determining severe trauma is essential for choosing the appropriate treatment strategy.
Objectives: The aim of this study was to find the predictive value of the quick sequential organ failure assessment (qSOFA) score for in-hospital mortality in adult trauma patients.
Methods: This prospective observational study was conducted on adult patients with multiple trauma presenting to the emergency department. The qSOFA score was calculated according to the initially recorded variables. The primary outcome was in-hospital mortality. The predictive value of qSOFA was evaluated using the Area Under Receiver Operating Characteristic (AUC) analysis.
Results: Finally, 775 multiple trauma patients with a mean age of 38.68±18.74 were admitted. Of these, 34 people (4.39%) died and 741 subjects were discharged from hospital. The mean qSOFA score was 0.41±0.64, significantly higher in the survived patients than in the non-survived patients (P < 0.001). The AUC of qSOFA score to predict in-hospital mortality was 0.878 (95% confidence interval: 0.853-0.900); thus, qSOFA was a good predictor of in-hospital mortality in multiple trauma patients.
Conclusion: The qSOFA score can be considered a simple and rapid screening tool for identifying multiple-trauma patients.


  1. Heydari F, Azizkhani R, Ahmadi O, Majidinejad S, Nasr-Esfahani M, Ahmadi A. Physiologic scoring systems versus Glasgow coma scale in predicting in-hospital mortality of trauma patients; a diagnostic accuracy study. Arch Acad Emerg Med. 2021;9(1).
  2. Heydari F, Maghami M-H, Esmailian M, Zamani M. The effect of implementation of the standard clinical practice guideline (CPG) for management of multiple trauma patients admitted to an emergency department. Adv J Emerg Med. 2018;2(1).
  3. Heydari F, Majidinejad S, Ahmadi A, Nasr‑Esfahani M, Shayannejad H, Fatemi NAS. A Comparison between Modified Early Warning Score, Worthing Physiological Scoring System, National Early Warning Score, and Rapid Emergency Medicine Score in Predicting Inhospital Mortality in Multiple Trauma Patients. Arch Trauma Res. 2021;10(4):189. doi:10.4103/atr.atr_31_21
  4. Mehmandar M, Soori H, Mehrabi Y. Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015. Int J Crit Illn Inj Sci. 2016;6(2):74-8. doi:10.4103/2229-5151.183017 PMid:27308255 PMCid:PMC4901831
  5. Rosen HE, Bari I, Paichadze N, Peden M, Khayesi M, Monclús J, et al. Global road safety 2010-18: An analysis of Global Status Reports. Injury. 2022. doi:10.1016/j.injury.2022.07.030
  6. Road safety in the Eastern Mediterranean Region: facts from the global status report on road safety 2018. World Health Organization. Regional Office for the Eastern Mediterranean; 2020.
  7. Galvagno Jr SM, Massey M, Bouzat P, Vesselinov R, Levy MJ, Millin MG, et al. Correlation between the revised trauma score and injury severity score: implications for prehospital trauma triage. Prehospital Emerg care. 2019;23(2):263-70. doi:10.1080/10903127.2018.1489019 PMid:30118369
  8. Jawa RS, Vosswinkel JA, McCormack JE, Huang EC, Thode HC, Shapiro MJ, et al. Risk assessment of the blunt trauma victim: The role of the quick Sequential Organ Failure Assessment Score (qSOFA). Am J Surg. 2017;214(3):397-401. doi:10.1016/j.amjsurg.2017.05.011 PMid:28622837
  9. Heydari F, Abbasi S, Shirani K, Zamani M, Masoumi B, Majidinejad S, et al. Predictive performance of qSOFA in confirmed COVID-19 patients presenting to the emergency department. Tzu Chi Med J. 2023;35(2):182-7. doi:10.4103/tcmj.tcmj_132_22 PMid:37261307 PMCid:PMC10227679
  10. Singer AJ, Ng J, Thode HC, Jr., Spiegel R, Weingart S. Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection. Ann Emerg Med. 2017;69 (4):475-9. doi:10.1016/j.annemergmed.2016.10.007 PMid:28110990
  11. Huang W, Yang P, Xu F, Chen D. Predictive value of qSOFA score for death in emergency department resuscitation room among adult trauma patients:a retrospective study. BMC Emerg Med. 2021;21(1):103. doi:10.1186/s12873-021-00498-0 PMid:34507543 PMCid:PMC8434734
  12. Ahun E, Köksal Ö, Sığırlı D, Torun G, Dönmez SS, Armağan E. Value of the Glasgow Coma Scale, age, and arterial blood pressure (GAP) score for predicting the mortality of major trauma patients presenting to the emergency department. Turkish J Trauma Emerg Surg. 2014;20(4):241-7. doi:10.5505/tjtes.2014.76399 PMid:25135017
  13. Roodsari N, Heydari F, Leyli E, Masouleh A, Bousari A, Asadi P. Predicting factors associated with in-hospital mortality in severe multiple-trauma patients. Arch Trauma Res. 2022;11(2):80-5. doi:10.4103/atr.atr_28_22
  14. Farzan N, Ghomi SYF, Mohammadi AR. A retrospective study on evaluating GAP, MGAP, RTS and ISS trauma scoring system for the prediction of mortality among multiple trauma patients. Ann Med Surg. 2022;76:103536. doi:10.1016/j.amsu.2022.103536 PMid:35495411 PMCid:PMC9052241
  15. Yadollahi M, Ghaedsharaf Z, Jamali K, Niakan MH, Pazhuheian F, Karajizadeh M. The Accuracy of GAP and MGAP Scoring Systems in Predicting Mortality in Trauma; a Diagnostic Accuracy Study. Front Emerg Med. 2020;4(3):e73.
  16. Lefering R. Trauma score systems for quality assessment. Eur J Trauma. 2002;28(2):52-63. doi:10.1007/s00068-002-0170-y
  17. Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15(4):1-8. doi:10.1186/cc10348 PMid:21831280 PMCid:PMC3387633
  18. Miyamoto K, Shibata N, Nakashima T, Kato S. Prehospital quick sequential organ failure assessment as a tool to predict in-hospital mortality. Am J Emerg Med. 2018;36(10):1832-6. doi:10.1016/j.ajem.2018.02.009 PMid:29463437
  19. Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital quick sequential organ failure assessment score to predict in-hospital mortality among patients with trauma. Am J Emerg Med. 2019;37(12):2165-70. doi:10.1016/j.ajem.2019.03.007 PMid:30878407
  20. Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital and in-hospital quick Sequential Organ Failure Assessment (qSOFA) scores to predict in-hospital mortality among trauma patients: an analysis of nationwide registry data. Acute Med Surg. 2020;7(1):e532. doi:10.1002/ams2.532 PMid:32587706 PMCid:PMC7311801