Wiener klinische Wochenschrift

, Volume 125, Issue 17–18, pp 508–515 | Cite as

Severity illness scoring systems for early identification and prediction of in-hospital mortality in patients with suspected sepsis presenting to the emergency department

  • Felicitas Geier
  • Steffen Popp
  • Yvonne Greve
  • Andreas Achterberg
  • Erika Glöckner
  • Renate Ziegler
  • Hans Jürgen Heppner
  • Harald Mang
  • Michael Christ
original article

Summary

The in-hospital mortality of patients with severe sepsis and septic shock (SSSS) is high. In this study we examined the diagnostic and prognostic accuracy of the emergency severity index (ESI), the modified early warning score (MEWS), and the mortality in emergency department (ED) sepsis (MEDS) score. This is a single-centre, prospective and observational study of 151 consecutive patients presenting to the ED of the Nuremberg Hospital with suspected sepsis (age 68.3 ± 18 years, 54.3 % men, 45 % with SSSS, in-hospital mortality of SSSS: 27.8 %). In this study, 37.7 % of the studied patients had a urinary tract infection (n = 57/151), 33.8 % a pneumonia (n = 51/151), 8.6 % an acute abdominal infection (n = 13/151), and in 12.6 % the focus of infection was not further specified or identifiable (n = 19/151). The diagnostic and prognostic accuracy was analyzed by means of the receiver operating characteristic (ROC) curve. The areas under curve (AUC) in terms of diagnostic accuracy were 0.609, 0.641, and 0.778 for the ESI, MEWS, and MEDS score respectively. The AUCs concerning prognostic accuracy were 0.617, 0.642, and 0.871 for ESI, MEWS, and MEDS score respectively.

By using the MEDS score systematically, critically ill patients with sepsis could be detected in the ED. Finally, the MEDS score provides the basis for a risk adjusted disposition management that follows objective criteria.

Keywords

sepsis emergency department severityillness scoring systems early identification prognosis 

Patienten mit Verdacht auf Sepsis in einer deutschen Notaufnahme: Risikostratifizierungsinstrumente zur Früherkennung und Prognoseabschätzung

Zusammenfassung

Patienten mit schwerer Sepsis bzw. septischem Schock (SSSS) weisen eine hohe Krankenhaussterblichkeit auf. In der vorliegenden Untersuchung soll die diagnostische und prognostische Güte des Emergency Severity Index (ESI), des Modified Early Warning Scores (MEWS) und des Mortality in Emergency Department Sepsis (MEDS) Scores untersucht werden. In einer monozentrischen, prospektiven Beobachtungsstudie wurden 151 konsekutive Patienten eingeschlossen, die sich mit Verdacht auf Sepsis in den Notaufnahmen des Klinikums Nürnberg vorstellten (Alter 68,3 ± 18 Jahre, 54,3 % Männer; 45 % mit SSSS; Krankenhaussterblichkeit der SSSS: 27,8 %). Bei 37,7 % der Patienten lag eine Harnwegsinfektion vor (n = 57/151), bei 33,8 % eine Pneumonie (n = 51/151), bei 8,6 % eine Infektion der Bauchorgane (n = 13/151) und bei 12,6 % wurde der Fokus nicht näher spezifiziert bzw. war nicht ermittelbar (n = 19/151). Die diagnostische und prognostische Güte wurde mithilfe der Receiver Operating Characteristic (ROC)-Kurve ermittelt. Folgende AUC’S (area under curve) resultierten für die diagnostische Güte von ESI, MEWS bzw. MEDS Score: 0,609, 0,641 bzw. 0,778. Die Berechnung der prognostischen Güte erbrachte folgende AUC’s für ESI, MEWS bzw. MEDS Score: 0,617, 0,642 bzw. 0,871.

Die systematische Verwendung des MEDS Scores könnte dazu beitragen, den schwer erkrankten Sepsispatienten in der Notaufnahme frühzeitig zu erkennen und die Dispositionsentscheidung risikoadjustiert zu treffen.

Schlüsselwörter

Sepsis Notaufnahme Risikostratifizierungsinstrumente Früherkennung Prognose 

Supplementary material

508_2013_407_MOESM1_ESM.pdf (17 kb)
(PDF 12 kb)
508_2013_407_MOESM2_ESM.pdf (511 kb)
(PDF 512 kb)

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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Felicitas Geier
    • 1
    • 4
  • Steffen Popp
    • 1
  • Yvonne Greve
    • 1
  • Andreas Achterberg
    • 1
  • Erika Glöckner
    • 1
  • Renate Ziegler
    • 2
  • Hans Jürgen Heppner
    • 1
    • 3
  • Harald Mang
    • 4
  • Michael Christ
    • 1
  1. 1.Department of Emergency and Critical Care MedicineCity Hospital NurembergNurembergGermanyGermany
  2. 2.Institute for Microbiology and HygieneCity Hospital NurembergNurembergGermany
  3. 3.Institute for Biomedicine of AgingFriedrich-Alexander-UniversityNuremberg-ErlangenGermany
  4. 4.Masters Degree Program, Medical Process ManagementFriedrich-Alexander-UniversityNuremberg-ErlangenGermany

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