African Internal Medicine Journal | 04 May 2015
Performance of the quick Sequential Organ Failure Assessment score for predicting in-hospital mortality in patients with suspected infection in rural Rwanda: a brief report
M, a, r, i, e, A, i, m, e, e, M, u, k, a, n, t, w, a, r, i, ,, J, e, a, n, d, e, D, i, e, u, U, w, i, m, a, n, a
Abstract
The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside tool used to identify patients with suspected infection who are at risk of poor outcomes. Its performance has been validated largely in high-resource settings, with limited evidence from rural, low-resource healthcare environments in sub-Saharan Africa. This study aimed to evaluate the performance of the qSOFA score for predicting in-hospital mortality among adult patients with suspected infection presenting to rural district hospitals in Rwanda. A retrospective cohort study was conducted using routinely collected clinical data from adult patients admitted with suspected infection. The qSOFA score was calculated at admission. Its discriminatory power for in-hospital mortality was assessed using the area under the receiver operating characteristic curve (AUROC). The qSOFA score demonstrated poor discriminatory ability for predicting in-hospital mortality, with an AUROC of 0.62. A qSOFA score of ≥2 had a low sensitivity of 28% for identifying patients who died. In this rural Rwandan setting, the qSOFA score performed poorly as a prognostic tool for in-hospital mortality in patients with suspected infection. Its utility as a standalone screening tool in this context is limited. Further research is needed to identify or develop context-appropriate, simple prognostic tools for sepsis in low-resource rural hospitals. Clinical reliance on the qSOFA score alone for risk stratification in such settings is not advised. qSOFA, sepsis, mortality, prognosis, low-resource setting, Rwanda, district hospital This brief report contributes African data on the performance of a widely promoted sepsis screening tool, highlighting the potential need for context-specific modifications in resource-limited environments.