Validation of the Mortality in Emergency Department Sepsis (MEDS) score in patients with the systemic inflammatory response syndrome (SIRS).
OBJECTIVE
To prospectively and externally validate the Mortality in Emergency Department Sepsis (MEDS) score as a predictor of 28-day mortality in patients who present to the emergency department with a systemic inflammatory response syndrome.


METHODS
Multicentered prospective cohort study.


METHODS
Emergency departments at the University of Colorado Hospital and Denver Health Medical Center in Denver, CO, and Albert Einstein Medical Center and the Hospital of the University of Pennsylvania in Philadelphia, PA.


METHODS
Adult patients who presented to the emergency department, who met criteria for systemic inflammatory response syndrome, and who were admitted to the hospital.


METHODS
The MEDS score was calculated by recording the presence of terminal illness, tachypnea or hypoxemia, septic shock, platelet count <150,000 cells/mm3, band count as a percentage of total white blood cell count >5%, age >65 yrs, lower respiratory infection, nursing home residence, and altered mental status.


RESULTS
Mortality within 28 days or discharged alive from the hospital.


RESULTS
In all, 385 patients were enrolled between 18 and 100 yrs of age. The overall mortality was 9%. As in the original article, the MEDS score was categorized into five groups: very low, low, moderate, high, and very high for 28-day mortality. Mortality rates for each group were 0.6% (95% confidence interval [CI], 0%-3%), 5% (95% CI, 1%-13%), 19% (95% CI, 11%-29%), 32% (95% CI, 15%-54%), and 40% (95% CI, 12%-74%), respectively. The MEDS score had an area under the receiver operating characteristic curve of 0.88 (95% CI, 0.83-0.92).


CONCLUSIONS
The MEDS score accurately predicts 28-day mortality in patients who present to the emergency department with systemic inflammatory response syndrome and who are admitted to the hospital.
Sankoff
Jeffrey D
JD
Division of Emergency Medicine, Department of Surgery, University of Colorado at Denver and Health Sciences Center, Denver, CO, USA. jeffrey.sankoff@uchsc.edu
Goyal
Munish
M
Gaieski
David F
DF
Deitch
Kenneth
K
Davis
Christopher B
CB
Sabel
Allison L
AL
Haukoos
Jason S
JS
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000401:mortality* / Q000628:therapy
D019344:Lactic Acid