The Mortality in Emergency Department Sepsis: 1-year mortality rates

The Mortality in Emergency Department Sepsis (MEDS) score is a previously derived, validated, and published clinical decision rule for predicting 28-day inhospital mortality. It is based on the following scoring system: underlying disease with expected fatality < 30 days or metastatic cancer (six points), tachypnea or hypoxia (three points), septic shock (three points), platelets < 150,000 (three points), bands > 5% (two points), age > 65 years (two points), lower respiratory infection (two points), nursing home resident (two points), anion gap, and altered mental status (two points). The points are added and a risk group assigned.

Objective

The objective of this study was to assess the ability of the MEDS score to predict 1-year mortality.

Methods

A prospective observational, cohort study of consecutive emergency department (ED) patients seen at an urban university hospital with 50,000 annual ED visits. The study period was1 February 2000–1 February 2001. All patients, aged 18 years or older, at risk for infection as indicated by the ED physician ordering a blood culture were included. The MEDS score divides patients into very low risk (0–4 points), low risk (5–7 points), moderate risk (8–12 points), high risk (13–15 points), and very high risk (> 15 points). The raw survival figures are reported with 95% confidence intervals (CIs) and compared with each other using Tukey's Test for pair-wise comparisons.

Results

Of 3926 patient visits eligible for the study, 3763 (96%) were included. The overall 1-year mortality was 24% (95% CI: 22.7–25.4%) (904/3763). The 1-year mortalities for the groups were: very low risk 8.6% (0.08–1.2%), low 23% (1.0–3.5%), moderate 40% (5.8–10%), high 68% (11–24%), and very high 79% (37–66%), with all groups being statistically different from each other by Tukey's Test for pair-wise comparisons.

Conclusions

The MEDS score is a good predictor of 1-year mortality in patients presenting to the ED with sepsis. Independent multicenter validation is needed prior to widespread application of this rule to test its performance in other patient populations.