title: Performance of the Mortality in Emergency Department Sepsis score for predicting hospital mortality among patients with severe sepsis and septic shock.
abstract: OBJECTIVE
  The aim of the study was to test if the Mortality in Emergency Department Sepsis (MEDS) score accurately predicts death among emergency department (ED) patients with severe sepsis and septic shock.
  
  
  METHODS
  This study was a preplanned secondary analysis of a before-and-after interventional study conducted at a large urban ED. Inclusion criteria were suspected infection, 2 or more criteria for systemic inflammation, and either systolic blood pressure of less than 90 mm Hg after a fluid bolus or lactate 4 mmol/L or higher. Exclusion criteria were: age of less than 18 years, no aggressive care desired, or need for immediate surgery. Clinical and outcomes data were prospectively collected on consecutive eligible patients for 1 year before and 1 year after implementing early goal-directed therapy (EGDT). The MEDS scores and probabilities of in-hospital death were calculated. The main outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate score performance.
  
  
  RESULTS
  One hundred forty-three patients, 79 pre-EGDT and 64 post-EGDT, were included. The mean age was 58 +/- 17 years, and pneumonia was the source of infection in 37%. The in-hospital mortality rate was 23%. The area under the receiver operating characteristic curve for MEDS to predict mortality was 0.61 (95% confidence interval [CI], 0.50-0.72) overall, 0.69 (95% CI, 0.56-0.82) in pre-EGDT patients, and 0.53 (95% CI, 0.33-0.74) in post-EGDT patients.
  
  
  CONCLUSIONS
  The MEDS score performed with poor accuracy for predicting mortality in ED patients with sepsis. These results suggest the need for further validation of the MEDS score before widespread clinical use.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA. alan.jones@carolinas.org
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.forename: Kristen
authors.initials: K
authors.lastname: Saak
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kline
mesh_terms: D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000401:mortality*; D012772:Shock, Septic / Q000401:mortality*