Skip to main content

Advertisement

Log in

Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department

  • EM - ORIGINAL
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

Sepsis is one of the most important causes of morbidity and mortality in patients presenting to the emergency department. SIRS criteria that define sepsis are not specific and do not reflect the severity of infection. We aimed to evaluate the ability of the modified mortality in emergency department sepsis (MEDS) score, the modified early warning score (MEWS) and the Charlson comorbidity index (CCI) to predict prognosis in patients who are diagnosed in sepsis. We prospectively investigated the value of the CCI, MEWS and modified MEDS Score in the prediction of 28-day mortality in patients presenting to the emergency department who were diagnosed with sepsis. 230 patients were enrolled in the study. In these patients, the 5-day mortality was 17 % (n = 40) and the 28-day mortality was 32.2 % (n = 74). A significant difference was found between surviving patients and those who died in terms of their modified MEDS, MEWS and Charlson scores for both 5-day mortality (p < 0.001, p = 0.013 and p = 0.006, respectively) and 28-day mortality (p < 0.001, p = 0.008 and p < 0.001, respectively). The area under the curve (AUC) for the modified MEDS score in terms of 28-day mortality was 0.77. The MEDS score had a greater prognostic value compared to the MEWS and CCI scores. The performance of modified MEDS score was better than that of other scoring systems, in our study. Therefore, we believe that the modified MEDS score can be reliably used for the prediction of mortality in sepsis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Antonopoulou A, Giamarellous-Bourboulis EJ (2011) Immunomodulation in sepsis: state of the art and future perspective. Immunotherapy 3:117–128

    Article  PubMed  CAS  Google Scholar 

  2. Heyland DK, Hopman V, Coo H, Tranmer J, McColl MA (2000) Long term health related quality of life in survivors of sepsis. Crit Care Med 289:3599–3605

    Article  Google Scholar 

  3. Raghavan M, Marik PE (2006) Management of sepsis during the early ‘golden hours’. J Emerg Med 31:185–199

    Article  PubMed  Google Scholar 

  4. Shapiro NI, Wolfe RE, Moore RB et al (2003) Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 31:670–675

    Article  PubMed  Google Scholar 

  5. Vorwerk C, Loryman B, Coats TJ et al (2009) Prediction of mortality in adult emergency department patients with sepsis. Emerg Med J26:254–258

    Google Scholar 

  6. Ghanem-Zoubi NO, Vardi M, Laor A, Weber G, Bitterman H (2011) Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments. Crit Care 15:R95

    Article  PubMed  Google Scholar 

  7. Bone RC, Balk RA, Cerra FB et al (1992) American College of Critical Care Medicine Consensus Conference: definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

    Article  Google Scholar 

  8. Crowe CA, Kulstad EB, Mistry CD, Kulstad CE (2010) Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock.J Emerg Trauma. Shock 3:342–347

    Google Scholar 

  9. Sankoff JD, Goyal M, Gaieski DF et al (2008) Validation of the Mortality in Emergency Department Sepsis (MEDS) score in patients with the systemic inflammatory response syndrome (SIRS). Crit Care Med 36:421–426

    Article  PubMed  Google Scholar 

  10. Jones AE, Saak K, Kline JA (2008) Performance of the Mortality in Emergency Department Sepsis score for predicting hospital mortality among patients with severe sepsis and septic shock. Am J Emerg Med 26:689–692

    Article  PubMed  Google Scholar 

  11. Howell MD, Donnino MW, Talmor D et al (2007) Performance of severity of illness scoring systems in emergency department patients with infection. Acad Emerg Med 14:709–714

    Article  PubMed  Google Scholar 

  12. Nguyen HB, Banta JE, Cho TW et al (2008) Mortality predictions using current physiologic scoring systems in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. Shock 30:23–28

    Article  PubMed  Google Scholar 

  13. Lee CC, Chen SY, Tsai CL et al (2008) Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department. Shock 29:322–327

    PubMed  Google Scholar 

  14. Carpenter CR, Keim SM, Upadhye S, Nguyen HB (2009) Risk stratification of the potentially septic patient in the emergency department: the Mortality in the Emergency Department Sepsis (MEDS) score. J Emerg Med 37:319–327

    Article  PubMed  Google Scholar 

  15. Stephenson JA, Gravante G, Butler NA et al (2010) The Systemic Inflammatory Response Syndrome (SIRS)–number and type of positive criteria predict interventions and outcomes in acute surgical admissions. World J Surg 34:2757–2764

    Article  PubMed  Google Scholar 

  16. Yang Y, Yang KS, Hsann YM, Lim V, Ong BC (2010) The effect of comorbidity and age on hospital mortality and length of stay in patients with sepsis. J Crit Care 25:398–405

    Article  PubMed  Google Scholar 

  17. Sun D, Aikawa N (1999) The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services. Keio J Med 48:28–37

    Article  PubMed  CAS  Google Scholar 

  18. Chen CC, Chong CF, Liu YL, Chen KC, Wang TL (2006) Risk stratification of severe sepsis patients in the emergency department. Emerg Med J23:281–285

    Google Scholar 

  19. Hermans MA, Leffers P, Jansen LM, Keulemans YC, Stassen PM (2011) The value of the mortality in emergency department sepsis (MEDS) score, C reactive protein and lactate in predicting 28-day mortality of sepsis in a Dutch emergency department. Emerg Med J10:1–6

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Halis Akalın.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Çıldır, E., Bulut, M., Akalın, H. et al. Evaluation of the modified MEDS, MEWS score and Charlson comorbidity index in patients with community acquired sepsis in the emergency department. Intern Emerg Med 8, 255–260 (2013). https://doi.org/10.1007/s11739-012-0890-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-012-0890-x

Keywords

Navigation