Comparison of scoring accuracy, assessment time, and preference between the Revised Quick Sequential Organ Failure Assessment score and National Early Warning Score: a within-subject simulation study

Background The Revised Quick Sequential Organ Failure Assessment (RqSOFA) score is a simple vital sign-based tool for identifying high-risk patients in the emergency department. Although RqSOFA has demonstrated predictive performance for in-hospital mortality that is at least comparable to that of the National Early Warning Score (NEWS), its practical characteristics have not been evaluated. This study compared RqSOFA and NEWS with respect to scoring accuracy, assessment time, and preference. Methods In this within-subject questionnaire-based simulation study, fifth-year medical students at a university-affiliated medical center assessed five simulated emergency cases using RqSOFA and NEWS, with the order of the assessment pages randomized, between 2025 and 2026. Scoring accuracy and assessment time were compared using paired participant-level analyses. Preference was evaluated using a three-category questionnaire (RqSOFA, NEWS, or no preference). Results Of 109 eligible students, 88 participated, and 87 (79.8%) were included in the final analysis. RqSOFA showed lower scoring accuracy than NEWS (95.9% vs. 98.9%; mean within-participant difference, 3.0% points; 95% confidence interval [CI], 0.9–5.1; P = 0.010). Assessment time was shorter with RqSOFA (19.7 vs. 28.3 s; median within-participant difference, 7.1 s; 95% CI, 5.8–9.0; P < 0.001). Preference favored RqSOFA in 82 participants, NEWS in 1, and neither in 4 (exact binomial test, P < 0.001). The difference in scoring accuracy was substantially influenced by the pneumonia scenario; when the pneumonia scenario was excluded, the estimated difference was 1.4% points (95% CI, − 0.3 to 3.2; P = 0.180). Conclusions Compared with NEWS, RqSOFA required less assessment time and was more strongly preferred by participants under standardized simulated conditions, whereas overall scoring accuracy was modestly lower. The observed difference in scoring accuracy was not consistent across the five scenarios, and the findings should not be interpreted as evidence of effects on clinical decision-making or patient outcomes.