title: Prognostic scores for early stratification of septic patients admitted to an emergency department-high dependency unit.
abstract: OBJECTIVE
  The aim of this study was to identify a reliable tool for the early prognostic stratification of septic patients admitted to the emergency department-high dependency unit (ED-HDU), a clinical setting providing a subintensive level of care; we also estimated the cost saving associated with HDU stay compared with ICU stay.
  
  
  METHODS
  Mortality in Emergency Department Sepsis (MEDS), Acute Physiology Age Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA) score (SOFA-T0) and the Charlson index were calculated at ED admission. SOFA score was also calculated after 24 h (SOFA-T1). The primary outcome was 28 days mortality.
  
  
  RESULTS
  We admitted 140 patients with severe sepsis or septic shock in our ED-HDU from June 2008 to December 2010; 135 were included in the study. One month's mortality was 29%. SOFA-T1 was significantly higher in patients who needed an ICU admission (7.5±3.8 vs. 5.3±3.0, P=0.048); it also showed the best mortality prediction ability (area under the curve 0.80, 95% confidence interval 0.70-0.91), compared with MEDS, SAPS, and APACHE score. Troponin and procalcitonin evaluated at ED admission and after 24 h did not show significant differences according to prognosis; patients with lactate more than 2 showed a higher mortality (40 vs. 22%, P=0.034). In a regression analysis adjusted for age, lactate value, and the Charlson index, SOFA-T1 (RR 1.551, 95% confidence interval 1.204-1.998, P<0.001) maintained an independent prognostic value for 28 days mortality. During the 267 days of stay at the ED-HDU, the total saving was &OV0556;460 041, compared with the cost of the same period in the ICU.
  
  
  CONCLUSIONS
  SOFA score is a feasible and accurate tool for an early risk stratification of septic patients admitted to the ED-HDU.
authors: High Dependency Unit, Department of Critical Care Medicine and Surgery, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
authors: Francesca
authors: F
authors: Innocenti
authors: Simone
authors: S
authors: Bianchi
authors: Elisa
authors: E
authors: Guerrini
authors: Sonia
authors: S
authors: Vicidomini
authors: Alberto
authors: A
authors: Conti
authors: Maurizio
authors: M
authors: Zanobetti
authors: Riccardo
authors: R
authors: Pini
mesh_terms: D018806:APACHE; D000368:Aged; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000191:economics / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality