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The Mortality in Emergency Department Sepsis Score as a Predictor of 1-Month Mortality among Adult Patients with Sepsis: Weighing the Evidence

DOI: 10.1155/2013/896802

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Objective. To evaluate the performance of Mortality in Emergency Department Sepsis (MEDS) score in comparison to biomarkers as a predictor of mortality in adult emergency department (ED) patients with sepsis. Methods. A literature search was performed using PubMed, ScienceDirect, SpringerLink, and Ovid databases. Studies were appraised by using the C2010 Consensus Process for Levels of Evidence for prognostic studies. The respective values for area under the curve (AUC) were obtained from the selected articles. Results. Four relevant articles met the selection process. Three studies defined the 1-month mortality as death occurring within 28 days of ED presentation, while the remaining one subcategorised the outcome measure as (5-day) early and (6- to 30-day) late mortality. In all four studies, the MEDS score performed better than the respective comparators (C-reactive protein, lactate, procalcitonin, and interleukin-6) in predicting mortality with an AUC ranging from 0.78 to 0.89 across the studies. Conclusion. The MEDS score has a better prognostic value than the respective comparators in predicting 1-month mortality in adult ED patients with suspected sepsis. 1. Case You have just attended to a 70-year-old male patient who presented to the emergency department (ED) with fever for 2 days associated with dysuria. He has a history of hypertension with previous ischaemic stroke and currently stays at a nursing home. On examination, he is lethargic but of normal mental status. His vital signs are as follows: temperature 38.8°C, heart rate 96 beats/min, blood pressure 110/70?mmHg, and respiratory rate 22 breaths/min. Urinalysis suggests a urinary tract infection. The white cell count is 16,000 per mm3 with 10% bands while the platelet count is 140,000 per mm3. Blood and urine cultures are sent and the appropriate antibiotics administered. Blood specimens for serum lactate and procalcitonin are also sent as part of the routine septic work-up in your ED, but the results are not available yet. Concerned about the risk of mortality and the applicability of early goal-directed therapy (EGDT) in this case, you wonder if there are any validated clinical prediction tools that can risk stratify ED patients with sepsis in a more timely manner. 2. Background Sepsis and its spectrum of clinical entities remain one of the common critical illnesses encountered in the emergency department (ED) with an estimated mortality rate of 20–30% in population-based studies [1, 2]. Timely identification with early institution of appropriate therapy for sepsis is essential for


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