Severity illness scoring systems for early identification and prediction of in-hospital mortality in patients with suspected sepsis presenting to the emergency department

Abstract

The in-hospital mortality of patients with severe sepsis and septic shock (SSSS) is high. In this study we examined the diagnostic and prognostic accuracy of the emergency severity index (ESI), the modified early warning score (MEWS), and the mortality in emergency department (ED) sepsis (MEDS) score. This is a single-centre, prospective and observational study of 151 consecutive patients presenting to the ED of the Nuremberg Hospital with suspected sepsis (age 68.3 ± 18 years, 54.3 % men, 45 % with SSSS, in-hospital mortality of SSSS: 27.8 %). In this study, 37.7 % of the studied patients had a urinary tract infection (n = 57/151), 33.8 % a pneumonia (n = 51/151), 8.6 % an acute abdominal infection (n = 13/151), and in 12.6 % the focus of infection was not further specified or identifiable (n = 19/151). The diagnostic and prognostic accuracy was analyzed by means of the receiver operating characteristic (ROC) curve. The areas under curve (AUC) in terms of diagnostic accuracy were 0.609, 0.641, and 0.778 for the ESI, MEWS, and MEDS score respectively. The AUCs concerning prognostic accuracy were 0.617, 0.642, and 0.871 for ESI, MEWS, and MEDS score respectively.By using the MEDS score systematically, critically ill patients with sepsis could be detected in the ED. Finally, the MEDS score provides the basis for a risk adjusted disposition management that follows objective criteria.

Efficacy of Emergency Severity Index (ESI) in Early Identification of Patients with Sepsis and Septic Shock at Triage

“…Hence Geier F et. al. identi ed that ESI triage system has weakness with regards to early identi cation of patient with sepsis, however patient with septic shock are able to identi ed reliably as with our results 12 Our study showed that 11.6% of the patients were categorized as ESI III, which is a high number considering the signi cant mortality associated with sepsis and further studies are required to assess the factors associated with the variation in categorization of these patients in ESI III and above.…”

Validity of the Manchester Triage System in patients with sepsis presenting at the ED: a first assessment

“…Geier et al 15 evaluated the Emergency Severity Index (ESI) in a prospective study in patients with severe sepsis and septic shock. The working group found a sensitivity of 70.8%, the NPV was 62.3% and the LR– was 64%.…”

Prognostic value of CD4+CD25+ Tregs as a valuable biomarker for patients with sepsis in ICU

“…[8] Therefore, it is pivotal to accurately predict prognosis of sepsis patients at different stages and to help optimize treatment options. There are few well-established scoring tools including APACHE II score, improved early warning score (modified early warning score, MEWS), and SOFA score, [9] which have been useful in predicting clinical outcomes.…”