@article {Vorwerk254, author = {C Vorwerk and B Loryman and T J Coats and J A Stephenson and L D Gray and G Reddy and L Florence and N Butler}, title = {Prediction of mortality in adult emergency department patients with sepsis}, volume = {26}, number = {4}, pages = {254--258}, year = {2009}, doi = {10.1136/emj.2007.053298}, publisher = {British Association for Accident and Emergency Medicine}, abstract = {Objectives: To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis.Methods: A retrospective cohort study of adult ED patients with sepsis admitted to hospital was conducted in a large urban teaching and a district general hospital. Data were collected during four time periods between 1 January 2006 and 31 January 2007. Inclusion criteria were age ⩾16 years and an ED diagnosis of sepsis. Primary outcome for all patients was 28-day mortality. Patients were preassigned to risk groups according to their abbreviated MEDS score, MEW score and NPT lactate.Results: 307 ED patients with sepsis were included in the study. Among these there were 72 deaths (23\%). Mortality rates for the low-, moderate- and high-risk groups of the abbreviated MEDS score were 1/63 (1.6\%), 48/205 (23.4\%) and 23/39 (59.0\%) patients. The MEDS score for low-risk patients was 98.6\% (95\% CI 92.5\% to 99.9\%) sensitive and 26.5\% (95\% CI 21.0\% to 32.6\%) specific and for high-risk patients it was 31.9\% (95\% CI 21.4\% to 44.0\%) sensitive and 93.2\% (95\% CI 89.2\% to 96.1\%) specific for death within 28 days. Mortality rates for the low- and high-risk MEW score were 20/159 (12.6\%) and 52/148 (35.1\%) patients. The MEW score for high-risk patients was 72.2\% (95\% CI 60.4\% to 82.1\%) sensitive and 59.2\% (95\% CI 52.6\% to 65.5\%) specific for mortality. An NPT lactate level of ⩾4 mmol/l was 49.1\% (95\% CI 35.1\% to 63.2\%) sensitive and 74.3\% (95\% CI 64.8\% to 82.3\%) specific for 28-day mortality.Conclusion: These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/26/4/254}, eprint = {https://emj.bmj.com/content/26/4/254.full.pdf}, journal = {Emergency Medicine Journal} }