title: Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic patient at the emergency department: a cohort study.
abstract: BACKGROUND
  Sepsis leads to high mortality, therefore risk stratification is important. The abbMEDS (abbreviated Mortality Emergency Department Sepsis) score assesses sepsis severity and predicts mortality. In community-acquired pneumonia, the CURB-65 (Confusion, Urea, Respiration, Blood pressure, Age) also provides support in clinical decisions regarding antibiotic treatment and clinical disposition. We investigated the predictive value and feasibility of the abbMEDS and CURB-65 in sepsis patients at the ED and the relationship between the scores and antibiotic treatment and clinical disposition (i.e. admission and type of ward).
  
  
  METHODS
  In this retrospective cohort study, we included 725 sepsis patients at the ED. We investigated the value in predicting 28-day mortality and feasibility of both scores. We calibrated the abbMEDS. We further assessed the relationship between the three risk categories per score and antibiotic treatment (i.e. oral and intravenous narrow or broad-spectrum) and clinical disposition.
  
  
  RESULTS
  Both abbMEDS and CURB-65 were good predictors of 28-day mortality (13.0%) (AUC 0.77 [95% CI 0.72 - 0.83] and 0.73 [95% CI 0.67 - 0.78], respectively) and feasible (complete score 92.7 and 93.9%, respectively). In the high risk category of the abbMEDS, all patients were admitted and treated with intravenous broad-spectrum antibiotics. In the high risk category of the CURB-65, 2.5% were not admitted and 4.4% received no antibiotics.
  
  
  CONCLUSIONS
  Both abbMEDS and CURB-65 are good predictors of 28-day mortality in septic ED patients. The abbMEDS is well calibrated and matches current clinical decisions concerning antibiotic treatment and clinical disposition, while this is less so for the CURB-65. In the future, use of the abbMEDS at the ED may improve sepsis care when its value as a decision support tool can be confirmed.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. a.roest1@vumc.nl.
authors.forename: Asselina A
authors.initials: AA
authors.lastname: Roest
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. J.Tegtmeier@student.maastrichtuniversity.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: Tegtmeier
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. joris_heyligen@hotmail.com.
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Heyligen
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. J.Duijst@alumni.maastrichtuniversity.nl.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Duijst
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. andrea.peeters@maastrichtuniversity.nl.
authors.forename: Andrea
authors.initials: A
authors.lastname: Peeters
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. hella.borggreve@mumc.nl.
authors.forename: Hella F
authors.initials: HF
authors.lastname: Borggreve
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Infectious Diseases, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. a.oudelashof@mumc.nl.
authors.forename: Astrid M L
authors.initials: AM
authors.lastname: Oude Lashof
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.|School CARIM, Maastricht University, Maastricht, The Netherlands. cda.stehouwer@mumc.nl.
authors.forename: Coen D A
authors.initials: CD
authors.lastname: Stehouwer
authors.affiliation: Department of Internal Medicine, Division of General Medicine, Section Acute Medicine, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands. p.stassen@mumc.nl.|School CAPHRI, Maastricht University, Maastricht, The Netherlands. p.stassen@mumc.nl.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Stassen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents