Comparison of the diagnostic and prognostic performance of qSOFA, SOFA and NEWS2 in adult patients with suspected sepsis in the emergency department: a literature review
DOI:
https://doi.org/10.12775/QS.2026.63.73277Keywords
sepsis, suspected sepsis, suspected infection, emergency department, qSOFA, SOFA, NEWS, NEWS2, National Early Warning ScoreAbstract
Early recognition of sepsis in the emergency department remains a major clinical challenge due to non-specific presentation, variable disease severity, and the need for rapid decision-making. Several scoring systems, including qSOFA, SOFA, and NEWS2, are used to support risk stratification in patients with suspected infection, but their diagnostic and prognostic performance differs according to clinical context and timing of assessment. This review aimed to compare the diagnostic and prognostic performance of qSOFA, SOFA, and NEWS2 in adult patients with suspected sepsis in the emergency department, with particular focus on clinical utility and practical applicability in early risk stratification.
References
1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200–211. doi:10.1016/S0140-6736(19)32989-7. PMID: 31954465.
2. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810. doi:10.1001/jama.2016.0287. PMID: 26903338.
3. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762–774. doi:10.1001/jama.2016.0288. PMID: 26903335.
4. Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med. 2019;37(8):1490–1497. doi:10.1016/j.ajem.2018.10.058. PMID: 30470600.
5. Brink A, Alsma J, Verdonschot RJCG, Rood PPM, Zietse R, Lingsma HF, et al. Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. PLoS One. 2019;14(1):e0211133. doi:10.1371/journal.pone.0211133.
6. Mellhammar L, Linder A, Tverring J, Christensson B, Boyd JH, Sendi P, et al. NEWS2 Is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department. J Clin Med. 2019;8(8):1128. doi:10.3390/jcm8081128. PMID: 31362432.
7. Durr D, Niemi T, Despraz J, et al. National Early Warning Score (NEWS) Outperforms Quick Sepsis-Related Organ Failure (qSOFA) Score for Early Detection of Sepsis in the Emergency Department. Antibiotics (Basel). 2022;11(11):1518. doi:10.3390/antibiotics11111518. PMID: 36358173.
8. Wang C, Xu R, Zeng Y, Zhao Y, Hu X. A comparison of qSOFA, SIRS and NEWS in predicting the accuracy of mortality in patients with suspected sepsis: A meta-analysis. PLoS One. 2022;17(4):e0266755. doi:10.1371/journal.pone.0266755. PMID: 35427367.
9. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Intensive Care Med. 2021;47(11):1181–1247. doi:10.1007/s00134-021-06506-y. PMID: 34599691.
10. Zonneveld LEEC, van Wijk RJ, Olgers TJ, Bouma HR, Ter Maaten JC. Prognostic value of serial score measurements of the National Early Warning Score, the quick Sequential Organ Failure Assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis. Eur J Emerg Med. 2022;29(5):348–356. doi:10.1097/MEJ.0000000000000924. PMID: 36062434.
11. Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: Royal College of Physicians; 2017.
12. Verma A, Farooq A, Jaiswal S, Haldar M, Sheikh WR, Khanna P, et al. National Early Warning Score 2 is superior to quick Sequential Organ Failure Assessment in predicting mortality in sepsis patients presenting to the emergency department in India: A prospective observational study. Int J Crit Illn Inj Sci. 2023;13(1):26–31. doi:10.4103/ijciis.ijciis_41_22. PMID: 37180301.
13. Boekhoud L, Schaap HMEA, Huizinga RL, Olgers TJ, Ter Maaten JC, Postma DF, et al. Predictive performance of NEWS and qSOFA in immunocompromised sepsis patients at the emergency department. Infection. 2024;52:1863–1873. doi:10.1007/s15010-024-02247-4.
14. Hincapié-Osorno C, van Wijk RJ, Postma DF, Koeze J, Ter Maaten JC, Jaimes F, et al. Validation of MEWS, NEWS, NEWS-2 and qSOFA for different infection foci at the emergency department, the Acutelines cohort. Eur J Clin Microbiol Infect Dis. 2024;43:2441–2452. doi:10.1007/s10096-024-04961-1. PMID: 39414696.
15. Oduncu AF, Kıyan GS, Yalçınlı S. Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department. Am J Emerg Med. 2021;48:54–59. doi:10.1016/j.ajem.2021.04.006. PMID: 33839632.
16. Abdullah SMOB, Sørensen RH, Nielsen FE. Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections. Infect Drug Resist. 2021;14:2763–2775. doi:10.2147/IDR.S304952. PMID: 34321893.
17. Saeed K, Wilson DC, Bloos F, Schuetz P, van der Does Y, Melander O, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care. 2019;23(1):40. doi:10.1186/s13054-019-2329-5. PMID: 30736862.
18. Wanlumkhao W, Rattanamongkolgul D, Ekpanyaskul C. Performance of Early Sepsis Screening Tools for Timely Diagnosis and Antibiotic Stewardship in a Resource-Limited Thai Community Hospital. Antibiotics (Basel). 2025;14(7):708. doi:10.3390/antibiotics14070708. PMID: 40724010.
19. Tusgul S, Carron PN, Yersin B, Calandra T, Dami F. Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital and emergency department setting. Scand J Trauma Resusc Emerg Med. 2017;25(1):108. doi:10.1186/s13049-017-0449-y. PMID: 29096769..
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ewa Wystalska, Kacper Solarz, Wojciech Warmuz, Łukasz Dylewicz, Joanna Brzoza, Kinga Bylica, Jakub Rudzki, Natalia Czołpińska, Zuzanna Kata, Jakub Andrzejewicz
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 46
Number of citations: 0
