Mortality in Emergency Department Sepsis (MEDS) score predicts 1-year mortality*

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Abstract

Objective:

To assess the predictive performance for 1-yr mortality of the previously derived and validated Mortality in Emergency Department Sepsis (MEDS) score.

Design:

Prospective cohort study.

Patients:

Consecutive adult (aged ≥18 yrs) emergency department patients presenting to an urban, tertiary care, university hospital were eligible if they had a clinically suspected infection as indicated by the decision to obtain a blood culture. The enrollment period was between February 1, 2000, and February 1, 2001. Of 3,926 eligible patient visits, 3,762 (96%) were enrolled and 3,102 unique first visits were analyzed.

Interventions:

None.

Measurements and Main Results:

A total of 667 patients (21.5%) died within 1 yr. The unadjusted 1-yr mortality rates for the MEDS risk groups were: very low risk, 7%; low risk, 20%; moderate risk, 37%; high risk, 64%; very high risk, 80%. Using a Cox proportional hazard model that controlled for age, sex, and Charlson co-morbidity index, the 1-yr hazard ratios compared with the baseline very low–risk group were: low risk, 2.2 (1.7–2.9); moderate risk, 3.5 (2.7–4.6); high risk, 6.7 (4.9–9.3); and very high risk, 10.5 (7.2–15.4). The groups were significantly different (p < .0001).

Conclusions:

Although the score was initially derived for 28-day in-hospital mortality, our results indicate that the MEDS score also predicts patient survival at 1 yr after index hospital visit with suspected infection. The score needs external validation before widespread use.

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