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Systematic review
Performance of the MEDS score in predicting mortality among emergency department patients with a suspected infection: a meta-analysis
  1. Gensheng Zhang1,
  2. Kai Zhang1,
  3. Xie Zheng2,
  4. Wei Cui1,3,
  5. Yucai Hong4,
  6. Zhongheng Zhang4
  1. 1 Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  2. 2 Department of Endocrinology, People’s Hospital of Anji, Zhejiang University School of Medicine, Anji, China
  3. 3 Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  4. 4 Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
  1. Correspondence to Dr Zhongheng Zhang, Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; zh_zhang1984{at}zju.edu.cn

Abstract

Objectives To carry out a meta-analysis to examine the prognostic performance of the Mortality in Emergency Department Sepsis (MEDS) score in predicting mortality among emergency department patients with a suspected infection.

Methods Electronic databases—PubMed, Embase, Scopus, EBSCO and the Cochrane Library—were searched for eligible articles from their respective inception through February 2019. Sensitivity, specificity, likelihood ratios and receiver operator characteristic area under the curve were calculated. Subgroup analyses were performed to explore the prognostic performance of MEDS in selected populations.

Results We identified 24 studies involving 21 246 participants. The pooled sensitivity of MEDS to predict mortality was 79% (95% CI 72% to 84%); specificity was 74% (95% CI 68% to 80%); positive likelihood ratio 3.07 (95% CI 2.47 to 3.82); negative likelihood ratio 0.29 (95% CI 0.22 to 0.37) and area under the curve 0.83 (95% CI 0.80 to 0.86). Significant heterogeneity was seen among included studies. Meta-regression analyses showed that the time at which the MEDS score was measured and the cut-off value used were important sources of heterogeneity.

Conclusion The MEDS score has moderate accuracy in predicting mortality among emergency department patients with a suspected infection. A study comparison MEDS and qSOFA in the same population is needed.

  • infection
  • emergency department

https://doi.org/10.1136/emermed-2019-208901

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    Footnotes

    • GZ and KZ contributed equally.

    • Contributors GZ and KZ contributed to the acquisition and analysis of the data and the initial writing of the draft of this paper. XZ, WC and YH contributed to the collection and interpretation of data. ZZ contributed to the concept of the review, the revision of this paper, and the final approval of the version to be published. GZ and KZ contributed equally to this work. ZZ takes responsibility for the content of the manuscript, including the data and analysis.

    • Funding This work was supported in part by grant from the National Natural Science Foundation of China (No. 81570017, No 81971871, to GZ; No 81901929, to ZZ).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.