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Performance of Severity of Illness Scoring Systems in Emergency Department Patients with Infection

  1. Michael D. Howell MD1,*,
  2. Michael W. Donnino MD1,
  3. Daniel Talmor MD4,
  4. Peter Clardy MD1,
  5. Long Ngo PhD2,
  6. Nathan I. Shapiro MD, MPH3

Article first published online: 28 JUN 2008

DOI: 10.1197/j.aem.2007.02.036

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 14, Issue 8, pages 709–714, August 2007

Additional Information

How to Cite

Howell, M. D., Donnino, M. W., Talmor, D., Clardy, P., Ngo, L. and Shapiro, N. I. (2007), Performance of Severity of Illness Scoring Systems in Emergency Department Patients with Infection. Academic Emergency Medicine, 14: 709–714. doi: 10.1197/j.aem.2007.02.036

Author Information

  1. 1

    Division of Pulmonary, Critical Care and Sleep Medicine Harvard Medical School, Boston, MA

  2. 2

    Department of Medicine Harvard Medical School, Boston, MA

  3. 3

    Department of Emergency Medicine Harvard Medical School, Boston, MA

  4. 4

    Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA

* Contact for correspondence and reprints: Michael D. Howell, MD (Email: mhowell@bidmc.harvard.edu).

Publication History

  1. Issue published online: 28 JUN 2008
  2. Article first published online: 28 JUN 2008
  3. Received July 28, 2006;Revised December 24, 2006;Revised February 17, 2007;Accepted February 18, 2007

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Keywords:

  • sepsis;
  • severity of illness;
  • septic shock;
  • risk stratification

ObjectivesTo validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection.

MethodsThis was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible. The MEDS and CURB-65 scores were calculated as originally described, but REMS was modified in neurologic scoring because a full Glasgow Coma Scale score was not uniformly available. Discrimination of each score was assessed with the area under the receiver operating characteristics curve (AUC).

ResultsOf 2,132 patients, 3.9% (95% confidence interval [CI] = 3.1% to 4.7%) died. Mortality stratified by the MEDS score was as follows: 0–4 points, 0.4% (95% CI = 0.0 to 0.7%); 5–7 points, 3.3% (95% CI = 1.7% to 4.9%); 8–12 points, 6.6% (95% CI = 4.4% to 8.8%); and ≥13 points, 31.6% (95% CI = 22.4% to 40.8%). Mortality stratified by CURB-65 was as follows: 0 points, 0% (0 of 457 patients); 1 point, 1.6% (95% CI = 0.6% to 2.6%); 2 points, 4.1% (95% CI = 2.3% to 6.0%); 3 points, 4.9% (95% CI = 2.8% to 6.9%); 4 points, 18.1% (95% CI = 11.9% to 24.3%); and 5 points, 28.0% (95% CI = 10.4% to 45.6%). Mortality stratified by the mREMS was as follows: 0–2 points, 0.6% (95% CI = 0 to 1.2%); 3–5 points, 2.0% (95% CI = 0.8% to 3.1%); 6–8 points, 2.3% (95% CI = 1.1% to 3.5%); 9–11 points, 7.1% (95% CI = 4.2% to 10.1%); 12–14 points, 20.0% (95% CI = 12.5% to 27.5%); and ≥15 points, 40.0% (95% CI = 22.5% to 57.5%). The AUCs were 0.85, 0.80, and 0.79 for MEDS, mREMS, and CURB-65, respectively.

ConclusionsIn this large cohort of patients with clinically suspected infection, MEDS, mREMS, and CURB-65 all correlated well with 28-day in-hospital mortality.

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