• emergency department
• infectious diseases, bacterial
• intensive care

Sepsis is a complex syndrome, where complexity is defined as having multiple interdependent parts. It has been a challenge to define it, and, as our understanding has evolved, so its definition has changed from the first iteration in 1991,1 to the second in 20012 and now a third in 2016.3

At its most basic sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.3 Singer et al have suggested that this organ dysfunction can be identified using an acute change in the Sequential Organ Failure Assessment (SOFA) score ≥2 points as a result of the infection.3

The problem with the SOFA score is that it does rely on some laboratory data, which makes it difficult to use outside hospital or at the ‘front door’. Singer et al then developed what they described as a ‘parsimonious clinical model’, which they termed the qSOFA (quick SOFA)3 based only on RR, systolic BP and altered mental state. One point is scored for (1) a RR ≥22 breaths per minute, (2) a systolic BP of ≤100 mm Hg and (3) altered mental state (GCS<15). A score of ≥2 in a patient with infection was associated with an increased risk of death.3

The new definition of sepsis and the role of qSOFA has aroused controversy (eg, refs.4–7). Two papers in this issue of the journal join in the controversy.

Rodriguez et al, in their cohort study from the USA, compared qSOFA with what they described as ‘the most commonly used current ED sepsis identification tools’, …