Mortality in Emergency Department Sepsis (MEDS) score: A prospectively derived and validated clinical prediction rule*

Shapiro, Nathan I.; Wolfe, Richard E.; Moore, Richard B.; Smith, Eric L.; Burdick, Elizabeth; Bates, David W.

doi:10.1097/01.ccm.0000054867.01688.d1

Cited by 456 publications

(423 citation statements)

References 30 publications

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“…Our results are similar to the AUC of 0.78 found among "allcomers" with sepsis in the original MEDS score validation study. 10 Again, patient selection may have accounted for these differing findings, because although our study represented a sicker group of patients, only around half the patients in our study were admitted to the ICU. Our study included patients in whom critical care admission was not deemed either necessary or appropriate or who died in the ED prior to transfer to the ICU.…”

Section: Discussionmentioning

confidence: 51%

“…22 For example, the MEDS score, the most frequently studied model, used the clinical decision to draw a blood culture as the enrollment criteria in its derivation cohort. 10 While subsequently found to be predictive of mortality up to 1 year among ED patients with sepsis, 11 other authors found that among patients with septic shock undergoing early goal-directed therapy (EGDT) resuscitation, predictive performance of MEDS for outcome was poor. 14 An additional limitation of the MEDS score is that a large weighting is given to a subjective assessment of short-term mortality by the treating clinician.…”

Section: Discussionmentioning

confidence: 99%

“…For the purposes of the PIRO and MEDS score calculations, we defined terms such as "shock," "respiratory failure," "terminal illness," etc., with reference to the relevant original papers. 10,17 All data were abstracted into a structured datasheet by a single investigator (SPJM). Because in the ED the majority of patients are not ventilated, a modification of the respiratory domain of the SOFA score was used based on the fraction of inspired oxygen (FiO 2 )/peripheral capillary oxygen saturation (SpO 2 ) ratio, where FiO 2 was known.…”

Section: Study Protocolmentioning

confidence: 99%

“…The Sequential Organ Failure Assessment (SOFA) and Mortality in Emergency Department Sepsis (MEDS) scores (Data Supplements S1 and S2, available as supporting information in the online version of this paper) use clinical and laboratory variables to grade the severity of organ failure and have been demonstrated to correlate with mortality among those admitted from the ED with sepsis. [8][9][10][11] The SOFA score uses only physiologic and laboratory variables but does not consider host factors such as age, ethnicity, and comorbid disease burden, which are important drivers of mortality in sepsis. 12,13 The MEDS score requires a subjective assessment of likelihood of short-term mortality and may perform less accurately at higher illness severity.…”

mentioning

confidence: 99%

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Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

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Objectives: The Predisposition Insult Response and Organ failure (PIRO) scoring system has been developed for use in the emergency department (ED) to risk stratify sepsis cases, but has not been well studied among high-risk patients with severe sepsis and septic shock. The PIRO score was compared with the Sequential Organ Failure Assessment (SOFA) and Mortality in ED Sepsis (MEDS) scores to predict mortality in ED patients with features suggesting severe sepsis or septic shock in the ED. Methods:This was an analysis of sepsis patients enrolled in a prospective observational ED study of patients presenting with evidence of shock, hypoxemia, or other organ failure. PIRO, MEDS, and SOFA scores were calculated from ED data. Analysis compared areas under the receiver operator characteristic (ROC) curves for 30-day mortality.Results: Of 240 enrolled patients, final diagnoses were septic shock in 128 (53%), severe sepsis without shock in 70 (29%), and infection with no organ dysfunction in 42 (18%). Forty-eight (20%) patients died within 30 days of presentation. Area under the ROC curve (AUC) for mortality was 0.86 (95% confidence interval [CI] = 0.80 to 0.92) for PIRO, 0.81 (95% CI = 0.74 to 0.88) for MEDS, and 0.78 (95% CI = 0.71 to 0.87) for SOFA scores. Pairwise comparisons of the AUC were as follows: PIRO versus SOFA, p = 0.01; PIRO versus MEDS, p = 0.064; and MEDS versus SOFA; p = 0.37. Mortality increased with increasing PIRO scores: PIRO < 5, 0%; PIRO 5 to 9, 5%; PIRO 10 to 14, 5%; PIRO 15 to 19, 37%; and PIRO ≥ 20, 80% (p < 0.001). The MEDS score also showed increasing mortality with higher scores: MEDS < 5, 0%; MEDS 5 to 7, 12%; MEDS 8 to 11, 15%; MEDS 12 to 14, 48%; and MEDS > 15, 65% (p < 0.001).Conclusions: The PIRO model, taking into account comorbidities and septic source as well as physiologic status, performed better than the SOFA score and similarly to the MEDS score for predicting mortality in ED patients with severe sepsis and septic shock. These findings have implications for identifying and managing high-risk patients and for the design of clinical trials in sepsis.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Study Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Secondary analyses of the primary outcome included odds ratio with adjustment for Mortality in Emergency Department Sepsis (MEDS) score components, sensitivity analyses for missing data, learning-curve analysis, and adherence-adjusted analysis. We conducted prespecified subgroup analyses by testing interactions between the effect of EGDT and the degree of protocolized care (in the usual-care group), age, MEDS score, 23 SOFA score, and the time from presentation at the emergency department to randomization.…”

Section: Discussionmentioning

confidence: 99%