Modified Sequential Organ Failure Assessment score for prehospital critical care: defining thresholds and clinical implications
In brief
mSOFA score of 8 or more signals over 45% two-day death risk
In a prospective cohort of 14,726 prehospital patients, a mSOFA of 8-10 points was linked to a 45% two-day mortality, rising to 76% when the score reached 11 or higher. Low scores (0-2) identified patients with virtually no short-term death risk, suggesting the score could guide triage, though prospective testing is still needed.
- Journal
- European journal of internal medicine (Q1)
- Published
- 19 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Carlos Del Pozo Vegas, Juan F Delgado Benito, Raúl López-Izquierdo, Isabel de la Torre, Erik Alonso, Santos Gracia Villar, et al.
- PMID
- 42763288
- DOI
- 10.1016/j.ejim.2026.107202
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 21 September 2026): Prehospital mSOFA thresholds, mortality risk stratification
Abstract
BACKGROUND: The modified Sequential Organ Failure Assessment (mSOFA) score demonstrates excellent discrimination for short-term mortality in prehospital settings; however, actionable risk stratification thresholds remain undefined. We aimed to determine and validate clinically relevant mSOFA cutoff points and evaluate their association with mortality and care intensity. METHODS: In this prospective, multicentre cohort study across three Spanish and one Austrian emergency medical services (Jan 1, 2021, to April 30, 2026) divided in derivation and validation cohorts, we included adults with acute disease evaluated by advanced life support units. The mSOFA score (0-17 points) was calculated using point-of-care biomarkers obtained within 15 min of patient contact. The primary outcome was 2-day in-hospital mortality. Optimal thresholds were determined using LOESS curves, Youden index, and monotonic trend analysis. RESULTS: Among 14,726 (plus 2100 for validation) patients (median age 67 years [IQR 51-80]; 5906 [40%] female), 2-day mortality was 5.6%. Five mSOFA categories demonstrated progressively increasing mortality: physiologic stability (0-2 points; n = 9436; mortality 0.1%), compensated at risk (3-4 points; n = 2623; mortality 2.5%), significant imbalance (5-7 points; n = 1781; mortality 16.1%), multiorgan failure (8-10 points; n = 673; mortality 45.3%), and critical multiorgan failure (≥11 points; n = 216; mortality 76.4%). Negative predictive values exceeded 98% in low-risk categories. These results were confirmed in validation datasets. CONCLUSIONS: This study establishes the first empirically derived thresholds for prehospital mSOFA scoring. The five-category framework demonstrated a robust mortality gradient and consistent associations with care intensity markers, providing a foundation for standardised triage protocols. Prospective validation is required before implementation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.