ORIGINAL ARTICLE

Risk stratification of severe sepsis patients in the emergency department

C-C Chen^1,3, C-F Chong^2,3, Y-L Liu³, K-C Chen³ and T-L Wang³

¹ Graduate Institute of Emergency and Critical Care Medicine, National Yang-Ming Medical University, Taipei, Taiwan
² School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
³ Emergency Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

Correspondence to:
Correspondence to:
Dr C-F Chong
School of Medicine, Fu Jen Catholic University, 510 Chung-Cheng Road, Hsin-Chuang Hsih, Taipei Hsien, Taipei 24205, Taiwan; jackchong{at}tmu.edu.tw

Objective: To determine the efficacy of the Mortality in Emergency Department Sepsis (MEDS) score in the stratification of patients who presented to the emergency department (ED) with severe sepsis.

Methods: Adults who presented to the ED with severe sepsis were retrospectively recruited and divided into group A (MEDS score <12) and group B (MEDS score 12). Their outcomes were evaluated with 28 day hospital mortality rate, length of hospital stay, Kaplan-Meier survival analysis, and receiver operating characteristic (ROC) analysis. Discriminatory power of the MEDS score in mortality prediction was further compared with the Acute Physiology and Chronic Health Evaluation (APACHE) II model.

Results: In total, 276 patients (44.6% men and 55.4% women) were analysed, with 143 patients placed in group A and 133 patients in group B. Patients with MEDS score 12 had a significantly higher mortality rate (48.9% v 17.5%, p<0.01) and higher median APACHE II score (25 v 20 points, p<0.01). Significant difference in mortality risk was also demonstrated with Kaplan-Meier survival analysis (log rank test, p<0.01). No difference in the length of hospital stay was found between the groups. ROC analysis indicated a better performance in mortality prediction by the MEDS score compared with the APACHE II score (ROC 0.75 v 0.62, p<0.01).

Conclusion: Our results showed that mortality risk stratification of severe sepsis patients in the ED with MEDS score is effective. The MEDS score also discriminated better than the APACHE II model in mortality prediction.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; DNAR, do not attempt resuscitation; ED, emergency department; ICU, intensive care unit; MEDS, Mortality in Emergency Department Sepsis; MPM, Mortality Probability Model; ROC, receiver operating characteristic; SAPS, Simplified Acute Physiology Score; SIRS, systemic inflammatory response syndrome; SOFA, Sequential Organ Failure Assessment

Keywords: intensive care unit; mortality; risk-stratification; sepsis

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This article has been cited by other articles:

• Vorwerk, C, Loryman, B, Coats, T J, Stephenson, J A, Gray, L D, Reddy, G, Florence, L, Butler, N (2009). Prediction of mortality in adult emergency department patients with sepsis. Emerg. Med. J. 26: 254-258 [Abstract] [Full Text]  

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