Risk Stratification of the Potentially Septic Patient in the Emergency Department: The Mortality in the Emergency Department Sepsis (MEDS) Score

J Emerg Med. 2009 Oct;37(3):319-27. doi: 10.1016/j.jemermed.2009.03.016. Epub 2009 May 8.

Abstract

Background: The prompt recognition and management of septic patients remains a challenge within the busy Emergency Department (ED). Prognostic screening aids have traditionally required time-delayed laboratory measurements not validated upon the emergency medicine population. Recently, a brief prognostic tool has been derived and subsequently validated in heterogeneous ED populations.

Clinical question: Can a risk-stratification tool predict 1-month mortality in ED patients with suspected infection?

Evidence review: Six studies evaluating the Mortality in the Emergency Department Sepsis (MEDS) score were identified and evaluated.

Results: Higher MEDS scores are associated with increasing mortality. MEDS score's short- and long-term prognostic accuracy is superior to other sepsis scales as well as isolated biomarkers C-reactive protein and procalcitonin. MEDS' prognostic accuracy in severe sepsis is inferior to undifferentiated systemic inflammatory response syndrome (SIRS) patients.

Conclusion: The MEDS score is an accurate and reliable prognostic tool for 28-day mortality in ED SIRS patients, but may not be optimal for those with severe sepsis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • C-Reactive Protein / analysis
  • Calcitonin / blood
  • Calcitonin Gene-Related Peptide
  • Emergency Service, Hospital
  • Evidence-Based Emergency Medicine
  • Female
  • Hospital Mortality
  • Humans
  • Lactic Acid / blood
  • Predictive Value of Tests
  • Prognosis
  • Protein Precursors / blood
  • ROC Curve
  • Risk Assessment
  • Sepsis / diagnosis*
  • Sepsis / mortality
  • Severity of Illness Index*
  • Systemic Inflammatory Response Syndrome / diagnosis
  • Systemic Inflammatory Response Syndrome / mortality

Substances

  • CALCA protein, human
  • Protein Precursors
  • Lactic Acid
  • Calcitonin
  • C-Reactive Protein
  • Calcitonin Gene-Related Peptide