Objective@#We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)–
negative result (qSOFA score <2 points) at
triage on the
compliance with
sepsis bundles among
patients with
sepsis who presented to the
emergency department (ED). @*
Methods @#Prospective
sepsis registry data from 11 urban
tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed.
Patients who met the Third International
Consensus Definitions for
Sepsis and
Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED
triage . The primary outcome was defined as 3-hour bundle
compliance , including
lactate measurement,
blood culture , broad-spectrum
antibiotics administration , and 30 mL/kg
crystalloid administration . Multivariate
logistic regression analysis to predict 3-hour bundle
compliance was performed. @*Results@#Among the 2,250
patients enrolled in the
registry , 2,087 fulfilled the
sepsis criteria. Only 31.4% (656/2,087) of the
sepsis patients had qSOFA scores ≥2 points at
triage .
Patients with qSOFA scores <2 points had lower
lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of
compliance with
lactate measurement (adjusted
odds ratio [aOR], 0.47; 95%
confidence interval [CI], 0.29–0.75),
antibiotics administration (aOR, 0.64; 95% CI, 0.52–0.78), and 30 mL/kg
crystalloid administration (aOR, 0.62; 95% CI, 0.49–0.77) within 3 hours from
triage were significantly lower in
patients with qSOFA scores <2 points. However, the rate of
compliance with
blood culture within 3 hours from
triage (aOR, 1.66; 95% CI, 1.33–2.08) was higher in
patients with qSOFA scores <2 points. @*Conclusion@#A qSOFA-
negative result at ED
triage is associated with low
compliance with
lactate measurement, broad-spectrum
antibiotics administration , and 30 mL/kg
crystalloid administration within 3 hours in
sepsis patients .