title: External validation of the MISSED score to predict mortality in patients with severe sepsis and septic shock in the emergency department.
abstract: OBJECTIVE
  The Mortality in Severe Sepsis in the Emergency Department (MISSED) score was derived to predict in-hospital mortality in septic patients in the emergency department (ED). The present study aimed to validate the MISSED score in patients receiving early goal-directed therapy (EGDT).
  
  
  METHODS
  Data were analyzed from 280 patients who received EGDT in a tertiary center ED in Korea. Age 65 years and above, albumin level 27 g/l or less, and international normalized ratio of at least 1.2 were variables included in the MISSED score.
  
  
  RESULTS
  With a cutoff point of 5.5, the odds ratio for death was 2.17 (95% confidence interval 1.18-4.02). Mortality rates with MISSED scores of 0,< 5.5, and ≥ 5.5 were 4.5, 13.4, and 25.2%, respectively. Although the score was less discriminatory in patients who had EGDT commenced in the ED, a MISSED score higher than 5.5 remained significant.
  
  
  CONCLUSIONS
  Further studies are required to validate the MISSED score in more diverse patients.
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Seung Mok
authors.initials: SM
authors.lastname: Ryoo
authors.forename: Shin
authors.initials: S
authors.lastname: Ahn
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.forename: Kyoung Soo
authors.initials: KS
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D056910:Republic of Korea; D055502:Secondary Prevention / Q000379:methods; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy