title: Usefulness of the Mortality in Severe Sepsis in the Emergency Department score in an urban tertiary care hospital.
abstract: BACKGROUND
  The Mortality in Severe Sepsis in the Emergency Department (MISSED) score is a newly proposed scoring system. The goal of this study is to determine if the MISSED score is generalizable to an urban tertiary care hospital.
  
  
  METHODS
  This is a retrospective chart review conducted from July 2012 to June 2014. Inclusion criteria consisted of adult emergency department (ED) patients with severe sepsis, defined as lactate level 4mmol/L or greater. Demographics, lactate, international normalized ratio (INR), albumin, intensive care unit admission, and ED intubation were analyzed using χ(2) test, t test, and logistic regression. The MISSED score was calculated using the variables albumin 27g/L or less, INR 1.3 or greater, and age 65years or older and analyzed using the area under the curve. The primary outcome was inhospital mortality.
  
  
  RESULTS
  A total of 182 patients met inclusion criteria, and mortality was 32%. Patients in the mortality group had older age (58.1±17.2 vs 62.7±14.7; P=.07), higher lactate (5.9±2.7 vs 7.3±3.1; P<.01), lower albumin (34.3±8.3 vs 25.6±7.1; P<.0001), higher INR (1.4±0.6 vs 2.4±1.9; P<.0001), ED intubation (21% vs 56%; P<.0001), and intensive care unit admission (41% vs 78%; P<.0001). The regression model found that albumin of 27g/L or less (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.36), INR 1.3 or greater (OR, 8.3; 95% CI, 3.35-20.51), and ED intubation (OR, 5.6; 95% CI, 2.56-12.35) predicted mortality. The area under the curve for the MISSED score was 0.78 (95% CI, 0.73-0.85).
  
  
  CONCLUSIONS
  The MISSED score is useful for predicting mortality in ED patients with severe sepsis.
authors.affiliation: Department of Emergency Medicine, Rutgers University-New Jersey Medical School, Newark, NJ 07103. Electronic address: Mccormde@njms.rutgers.edu.
authors.forename: Denise
authors.initials: D
authors.lastname: McCormack
authors.affiliation: Department of Emergency Medicine, Rutgers University-New Jersey Medical School, Newark, NJ 07103. Electronic address: Ruderman@njms.rutgers.edu.
authors.forename: Avi
authors.initials: A
authors.lastname: Ruderman
authors.affiliation: Rutgers University-School of Biomedical Sciences, Newark, NJ 07103. Electronic address: wmm49@gsbs.rutgers.edu.
authors.forename: William
authors.initials: W
authors.lastname: Menges
authors.affiliation: Department of Emergency Medicine, Rutgers University-New Jersey Medical School, Newark, NJ 07103. Electronic address: Kulkarmi@njms.rutgers.edu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kulkarni
authors.affiliation: Department of Emergency Medicine, Rutgers University-New Jersey Medical School, Newark, NJ 07103. Electronic address: Muranote@njms.rutgers.edu.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Murano
authors.affiliation: Rutgers University-New Jersey Medical School, 183 South Orange Avenue Room E 1536, Newark, NJ 07103. Electronic address: skeller@njms.rutgers.edu.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Keller
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006786:Hospitals, Urban; D006801:Humans; D019934:International Normalized Ratio; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality* / Q000628:therapy; D012709:Serum Albumin; D012720:Severity of Illness Index; D062606:Tertiary Care Centers
chemical_list: D012709:Serum Albumin