Are scoring systems sufficient for predicting mortality due to sepsis in the emergency department?

Abstract

ObjectivesScoring systems have been used to risk stratify in intensive care units (ICU), but not routinely used in emergency departments. The aim of this study was to determine accuracy for predicting mortality in emergency medicine with Sequential Organ Failure Assessment (SOFA), Mortality in ED Sepsis (MEDS) score and Simplified Acute Physiology Score (SAPSII).MethodsThis is a prospective observational study. Patients presenting with evidence of sepsis were all included. SAPSII, MEDS, and SOFA scores were calculated. Analysis compared areas under the receiver operator characteristic (ROC) curves for 28-day mortality.ResultsTwo hundred patients were included; consisting of 31 (14.3%) septic shock. 138 (69%) severe sepsis and 31 (15.5%) infection without organ dysfunction. 53 (26.5%) patients died within 28 days.Area under the ROC curve for mortality was 0.76 for MEDS (0.69–0.82), 0.70 for SAPSII (0.62–0.78); and 1.68 for SOFA (0.60–0.76) scores. Pair wise comparison of AUC between MEDS, SAPSII, SOFA and Lactate were not significant.ConclusionAccording to our results; SOFA, SAPSII and MEDS were not sufficient to predict mortality. Also this result, MEDS was better than other scoring system.

Performance of the MEDS score in predicting mortality among emergency department patients with a suspected infection: a meta-analysis

“…We included 24 articles involving 21 246 patients in our meta-analysis14 21–43 (figure 1). Table 1 lists the sensitivity and specificity of included studies, online supplementary table 2 provides a description of the included articles and online supplementary table 3 is a list of excluded articles with reasons for exclusion.…”

“…The stated cut-off value for prediction of mortality using the MEDS score ranged from 7 to 14.5 across the included studies; however, seven studies14 22 25 33 37–39 did not state whether the cut-off value was prespecified or not. Only eight studies21 23 26 27 32 36 41 43 used a prespecified cut-off value and nine studies24 28–31 34 35 40 42 chose an optimal cut-off value based on the Youden index. For the outcome measured, five studies24 28 37 39 43 used in-hospital mortality, and 19 studies14 21–23 25–27 29–36 38 40–42 used 28/30-day mortality.…”

“…Only eight studies21 23 26 27 32 36 41 43 used a prespecified cut-off value and nine studies24 28–31 34 35 40 42 chose an optimal cut-off value based on the Youden index. For the outcome measured, five studies24 28 37 39 43 used in-hospital mortality, and 19 studies14 21–23 25–27 29–36 38 40–42 used 28/30-day mortality. The time when researchers calculated the MEDS score was reported in 16 articles,14 22–25 28–31 34 37–42 all of which calculated the MEDS score within 24 hours after patient ED enrolment.…”

“…For the outcome measured, five studies24 28 37 39 43 used in-hospital mortality, and 19 studies14 21–23 25–27 29–36 38 40–42 used 28/30-day mortality. The time when researchers calculated the MEDS score was reported in 16 articles,14 22–25 28–31 34 37–42 all of which calculated the MEDS score within 24 hours after patient ED enrolment. Two studies25 33 required us to contact the authors to obtain the necessary details to conduct our analyses.…”

“…In our meta-analysis, we found that the MEDS score cut-off values for predicting mortality varied substantially across studies, ranging from 7 to 14.5. The majority of studies included in our meta-analysis14 22 23 25–27 29 31–33 37 38 40–43 chose MEDS scores of 8 to 12 (most frequently 8) as the optimal cut-off value. The original MEDS score was derived from ED patients with suspected infection with a mortality rate of 5.3%.…”