title: Mortality in Emergency Department Sepsis (MEDS) score predicts 1-year mortality.
abstract: OBJECTIVE
  To assess the predictive performance for 1-yr mortality of the previously derived and validated Mortality in Emergency Department Sepsis (MEDS) score.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Consecutive adult (aged > or =18 yrs) emergency department patients presenting to an urban, tertiary care, university hospital were eligible if they had a clinically suspected infection as indicated by the decision to obtain a blood culture. The enrollment period was between February 1, 2000, and February 1, 2001. Of 3,926 eligible patient visits, 3,762 (96%) were enrolled and 3,102 unique first visits were analyzed.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 667 patients (21.5%) died within 1 yr. The unadjusted 1-yr mortality rates for the MEDS risk groups were: very low risk, 7%; low risk, 20%; moderate risk, 37%; high risk, 64%; very high risk, 80%. Using a Cox proportional hazard model that controlled for age, sex, and Charlson co-morbidity index, the 1-yr hazard ratios compared with the baseline very low-risk group were: low risk, 2.2 (1.7-2.9); moderate risk, 3.5 (2.7-4.6); high risk, 6.7 (4.9-9.3); and very high risk, 10.5 (7.2-15.4). The groups were significantly different (p < .0001).
  
  
  CONCLUSIONS
  Although the score was initially derived for 28-day in-hospital mortality, our results indicate that the MEDS score also predicts patient survival at 1 yr after index hospital visit with suspected infection. The score needs external validation before widespread use.
authors.affiliation: Department of Emergency Medicine, Pulmonary and Critical Care Division, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.forename: Michael
authors.initials: M
authors.lastname: Donnino
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards; D018805:Sepsis / Q000145:classification* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors