Sepsis scoring systems: comparison and practical use
A concise overview of common bedside tools used to flag high-risk infection and to predict deterioration, septic shock, and mortality. Performance varies by setting (ED vs ward vs ICU) and by threshold.
Patient-friendly explainer: If you want the key ideas without calculators or jargon, read
How scoring works (patient version).
At-a-glance comparison
- qSOFA (RR ≥22, SBP ≤100, altered mentation): very fast; tends to have higher specificity but lower sensitivity at common thresholds.
- NEWS / NEWS2: broader physiologic early warning; often more sensitive for deterioration, but requires more inputs and a chart/scale.
- SIRS: historically sensitive but less specific; can over-trigger and miss “SIRS-negative” sepsis.
- SOFA: more data-intensive (often ICU/labs); strong prognostic utility for mortality and organ dysfunction.
Predicting mortality and deterioration
- In ICU patients with suspected infection, SOFA increase showed greater prognostic accuracy for in-hospital mortality than SIRS or qSOFA.
- In ED patients with suspected infection, qSOFA showed greater prognostic accuracy for in-hospital mortality than SIRS/severe sepsis criteria.
- Systematic reviews comparing qSOFA with early warning scores (NEWS/NEWS2/MEWS) commonly report a sensitivity–specificity tradeoff: NEWS tends to be more sensitive; qSOFA more specific at typical thresholds.
Septic shock prediction
No single bedside score perfectly predicts progression to septic shock. Scores are best used to trigger rapid reassessment, early lactate testing, and escalation pathways, particularly in high-risk groups.
How to use (practical)
- Pre-hospital / triage: NEWS/NEWS2 can be helpful to identify physiological deterioration early.
- Rapid bedside screen: qSOFA is simple when time and data are limited.
- ICU / organ failure tracking: SOFA is appropriate when laboratory data are available.