Scoring patients with a suspected infection in the emergency department (ED): comparison of the ED-specific MEDS score with APACHE II and SOFA score

Introduction

Several scores exist for characterization of critically ill patients, developed in part for septic patients especially for the ICU patient (for example, Acute Physiology and Chronic Health Evaluation, APACHE II; Sequential Organ Failure Assessment, SOFA), but also for the septic patient in the emergency department (ED) (Mortality in Emergency Department Sepsis, MEDS). The practicability of these scores in the ED is discussed controversially. The aim of our study was to directly compare these scores in the setting of an ED on a cohort of patients with suspected infection.

Methods

Patients with suspected severe infection from which blood cultures were taken were included in the study. Procalcitonin (PCT) levels were determined, and APACHE II, MEDS and SOFA scores were calculated at admission. Endpoints were 28-day-mortality and necessity for therapy on an ICU. Receiver operating characteristic (ROC) curve analysis was performed to compare the ability of the three scores to predict the endpoints.

Results

We analyzed 211 patients. Eighty-two patients (43.6%) had a PCT value ≥2 ng/ml and were considered septic. Mean values of APACHE II, MEDS and SOFA score were 16.1 ± 8.5, 7.4 ± 4.7, and 3.4 ± 3.1 respectively. Tables 1 and 2 show the area under the curve (AUC) values of the ROC curves for mortality (Table 1) and ICU therapy (Table 2).

Table 1 ROC analysis for mortality

Table 2 ROC analysis for ICU therapy

Conclusions

All three scores are useful prognostic factors for mortality and for ICU therapy in the ED, with usually lower patients' severity of infection than in the ICU. The ICU-validated APACHE II and SOFA scores were of similar prognostic value as the ED-specific MEDS score.