Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department

Abstract

Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis.

Early Warning Scores do not accurately predict mortality in sepsis: A meta-analysis and systematic review of the literature

“…Four studies were performed in emergency departments [22][23][24]27 ; two were in internal medicine. 25,26 Three studies were relatively small in size (<400 participants), 23,24,27 one was moderate (n=535) 26 and two included more than 1000 participants. 22,25 Five studies used the MEWS system, one study used the National Early Warning Score (NEWS), a slight variation.…”

Sepsis recognition in the emergency department – impact on quality of care and outcome?

“…To compare disease severity in different sepsis subgroups, we calculated the MEWS, consisting of several vital signs, and the AVPU score in all patients, as well as the modified Mortality in Emergency Department Sepsis (mMEDS) score [20, 21], which incorporates several risk factors (terminal illness, tachypnea/hypoxia, septic shock, platelet count <150,000/mm 3 , age >65 years, lower respiratory tract infection, nursing home residency, altered mental state). A contemporary version of the Charlson Comorbidity Index (CCI) was used to compare chronic disease burden [22].…”

Development and Validation of a Quick Sepsis-Related Organ Failure Assessment-Based Machine-Learning Model for Mortality Prediction in Patients with Suspected Infection in the Emergency Department

“…However, several meta-analyses of qSOFA scores have shown that these scores had a poor sensitivity for predicting in-hospital mortality [10][11][12][13][14]. Early warning scores [15,16], a tool for identifying hospitalized patients at risk of deterioration, have been proposed for predicting hospital mortality in those with suspected sepsis in the ED [7,[17][18][19][20]. However, Hamilton et al reported that the early warning scores were not accurate in predicting sepsis mortality in the ED (67% of sensitivity and 60% of specificity) [21].…”