title: Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments.
abstract: BACKGROUND
  Due to the increasing burden on hospital systems, most elderly patients with non-surgical sepsis are admitted to general internal medicine departments. Disease-severity scoring systems are used for stratification of patients for utilization management, performance assessment, and clinical research. Some widely used scoring systems for septic patients are inappropriate when rating non-surgical patients in a non-intensive care unit (ICU) environment mainly because their calculations require types of data that are frequently unavailable. This study aimed to assess the fitness of four scoring systems for septic patients hospitalized in general internal medicine departments: modified early warning score (MEWS), simple clinical score (SCS), mortality in emergency department sepsis (MEDS) score, and rapid emergency medicine score (REMS).
  
  
  METHODS
  We prospectively collected computerized data of septic patients admitted to general internal medicine departments in our community-based university hospital. We followed 28-day in-hospital mortality, overall in-hospital mortality, and 30- and 60-day mortality. Using a logistic regression procedure we calculated the area under ROC curve (AUC) for every scoring system.
  
  
  RESULTS
  Between February 1st, 2008 and April 30th, 2009 we gathered data of 1,072 patients meeting sepsis criteria on admission to general internal medicine departments. The 28-day mortality was 19.4%. The AUC for the MEWS was 0.65-0.70, for the SCS 0.76-0.79, for the MEDS 0.73-0.75, and for the REMS, 0.74-0.79. Using Hosmer-Lemeshow statistics, a lack of fit was found for the MEDS model. All scoring systems performed better than calculations based on sepsis severity.
  
  
  CONCLUSIONS
  The SCS and REMS are the most appropriate clinical scores to predict the mortality of patients with sepsis in general internal medicine departments.
authors.affiliation: Carmel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Technion City, Haifa 32000, Israel. nesrin_gh@yahoo.com
authors.forename: Nesrin O
authors.initials: NO
authors.lastname: Ghanem-Zoubi
authors.forename: Moshe
authors.initials: M
authors.lastname: Vardi
authors.forename: Arie
authors.initials: A
authors.lastname: Laor
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weber
authors.forename: Haim
authors.initials: H
authors.lastname: Bitterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D006748:Hospital Departments / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D018805:Sepsis / Q000401:mortality*; D012720:Severity of Illness Index