Risk stratification of the potentially septic patient in the emergency department: the Mortality in the Emergency Department Sepsis (MEDS) score.
BACKGROUND
The prompt recognition and management of septic patients remains a challenge within the busy Emergency Department (ED). Prognostic screening aids have traditionally required time-delayed laboratory measurements not validated upon the emergency medicine population. Recently, a brief prognostic tool has been derived and subsequently validated in heterogeneous ED populations.


OBJECTIVE
Can a risk-stratification tool predict 1-month mortality in ED patients with suspected infection?


METHODS
Six studies evaluating the Mortality in the Emergency Department Sepsis (MEDS) score were identified and evaluated.


RESULTS
Higher MEDS scores are associated with increasing mortality. MEDS score's short- and long-term prognostic accuracy is superior to other sepsis scales as well as isolated biomarkers C-reactive protein and procalcitonin. MEDS' prognostic accuracy in severe sepsis is inferior to undifferentiated systemic inflammatory response syndrome (SIRS) patients.


CONCLUSIONS
The MEDS score is an accurate and reliable prognostic tool for 28-day mortality in ED SIRS patients, but may not be optimal for those with severe sepsis.
Carpenter
Christopher R
CR
Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Keim
Samuel M
SM
Upadhye
Suneel
S
Nguyen
H Bryant
HB
D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D055416:Evidence-Based Emergency Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000401:mortality
C000606589:CALCA protein, human; D011498:Protein Precursors; D019344:Lactic Acid; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide