Almost half of patients with a suspected infection experience a change in the score of qSOFA, SIRS, MEWS and/or NEWS during ED stay.

Approximately half of alterations were from a normal to an abnormal score and half vice versa.

The respiratory rate was the most contributing vital sign to these alterations.

Patients with a normal score at ED arrival had a 6.7–17.6% chance of displaying an abnormal score later during their ED stay, whereas 50% of patients with an initial abnormal score turned normal later on.

Clinicians should be aware of the frequency of alterations in clinical rule scores and realise that the optimal moment of assessing clinical rule scores is unknown.

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