OBJECTIVES: To validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection. METHODS: This was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible. The MEDS and CURB-65 scores were calculated as originally described, but REMS was modified in neurologic scoring because a full Glasgow Coma Scale score was not uniformly available. Discrimination of each score was assessed with the area under the receiver operating characteristics curve (AUC). RESULTS: Of 2,132 patients, 3.9% (95% confidence interval [CI] = 3.1% to 4.7%) died. Mortality stratified by the MEDS score was as follows: 0-4 points, 0.4% (95% CI = 0.0 to 0.7%); 5-7 points, 3.3% (95% CI = 1.7% to 4.9%); 8-12 points, 6.6% (95% CI = 4.4% to 8.8%); and > or = 13 points, 31.6% (95% CI = 22.4% to 40.8%). Mortality stratified by CURB-65 was as follows: 0 points, 0% (0 of 457 patients); 1 point, 1.6% (95% CI = 0.6% to 2.6%); 2 points, 4.1% (95% CI = 2.3% to 6.0%); 3 points, 4.9% (95% CI = 2.8% to 6.9%); 4 points, 18.1% (95% CI = 11.9% to 24.3%); and 5 points, 28.0% (95% CI = 10.4% to 45.6%). Mortality stratified by the mREMS was as follows: 0-2 points, 0.6% (95% CI = 0 to 1.2%); 3-5 points, 2.0% (95% CI = 0.8% to 3.1%); 6-8 points, 2.3% (95% CI = 1.1% to 3.5%); 9-11 points, 7.1% (95% CI = 4.2% to 10.1%); 12-14 points, 20.0% (95% CI = 12.5% to 27.5%); and > or = 15 points, 40.0% (95% CI = 22.5% to 57.5%). The AUCs were 0.85, 0.80, and 0.79 for MEDS, mREMS, and CURB-65, respectively. CONCLUSIONS: In this large cohort of patients with clinically suspected infection, MEDS, mREMS, and CURB-65 all correlated well with 28-day in-hospital mortality.
OBJECTIVES: To validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Ureanitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection. METHODS: This was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible. The MEDS and CURB-65 scores were calculated as originally described, but REMS was modified in neurologic scoring because a full Glasgow Coma Scale score was not uniformly available. Discrimination of each score was assessed with the area under the receiver operating characteristics curve (AUC). RESULTS: Of 2,132 patients, 3.9% (95% confidence interval [CI] = 3.1% to 4.7%) died. Mortality stratified by the MEDS score was as follows: 0-4 points, 0.4% (95% CI = 0.0 to 0.7%); 5-7 points, 3.3% (95% CI = 1.7% to 4.9%); 8-12 points, 6.6% (95% CI = 4.4% to 8.8%); and > or = 13 points, 31.6% (95% CI = 22.4% to 40.8%). Mortality stratified by CURB-65 was as follows: 0 points, 0% (0 of 457 patients); 1 point, 1.6% (95% CI = 0.6% to 2.6%); 2 points, 4.1% (95% CI = 2.3% to 6.0%); 3 points, 4.9% (95% CI = 2.8% to 6.9%); 4 points, 18.1% (95% CI = 11.9% to 24.3%); and 5 points, 28.0% (95% CI = 10.4% to 45.6%). Mortality stratified by the mREMS was as follows: 0-2 points, 0.6% (95% CI = 0 to 1.2%); 3-5 points, 2.0% (95% CI = 0.8% to 3.1%); 6-8 points, 2.3% (95% CI = 1.1% to 3.5%); 9-11 points, 7.1% (95% CI = 4.2% to 10.1%); 12-14 points, 20.0% (95% CI = 12.5% to 27.5%); and > or = 15 points, 40.0% (95% CI = 22.5% to 57.5%). The AUCs were 0.85, 0.80, and 0.79 for MEDS, mREMS, and CURB-65, respectively. CONCLUSIONS: In this large cohort of patients with clinically suspected infection, MEDS, mREMS, and CURB-65 all correlated well with 28-day in-hospital mortality.
Authors: Muge Capan; Danielle Mosby; Kristen Miller; Jun Tao; Pan Wu; William Weintraub; Rebecca Kowalski; Ryan Arnold Journal: Am J Hosp Med Date: 2018-02-16
Authors: Lance B Becker; Tom P Aufderheide; Romergryko G Geocadin; Clifton W Callaway; Ronald M Lazar; Michael W Donnino; Vinay M Nadkarni; Benjamin S Abella; Christophe Adrie; Robert A Berg; Raina M Merchant; Robert E O'Connor; David O Meltzer; Margo B Holm; William T Longstreth; Henry R Halperin Journal: Circulation Date: 2011-10-03 Impact factor: 29.690
Authors: J Wilhelm; S Hettwer; D Hammer; M Schürmann; A Christoph; M Amoury; T Klöss; R Finke; H Ebelt; K Werdan Journal: Med Klin Intensivmed Notfmed Date: 2012-08-10 Impact factor: 0.840
Authors: Felicitas Geier; Steffen Popp; Yvonne Greve; Andreas Achterberg; Erika Glöckner; Renate Ziegler; Hans Jürgen Heppner; Harald Mang; Michael Christ Journal: Wien Klin Wochenschr Date: 2013-08-10 Impact factor: 1.704
Authors: R Andrew Taylor; Joseph R Pare; Arjun K Venkatesh; Hani Mowafi; Edward R Melnick; William Fleischman; M Kennedy Hall Journal: Acad Emerg Med Date: 2016-02-13 Impact factor: 3.451
Authors: Julian M Williams; Jaimi H Greenslade; Juliet V McKenzie; Kevin H Chu; Anthony F T Brown; David Paterson; Jeffrey Lipman Journal: BMC Infect Dis Date: 2011-01-26 Impact factor: 3.090