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Overview :
Shapiro et al developed the Mortality in Emergency Department
Sepsis (MEDS) score to evaluate patients presenting with sepsis to the Emergency
Department. This can help stratify patients into risk groups and can help
identify patients who may require more aggressive management. The authors are
from Beth Israel Deaconess Medical Center, Brigham and Women's Hospital and
Harvard Medical School in Boston.
Parameters:
(1)
terminal illness, with death expected in less than 30 days (metastatic cancer or
underlying disease with > 50% likelihood of death within 30 days)
(2)
tachypnea (respiratory rate > 20 breaths per minute) or hypoxia (oxygen
saturation < 90%)
(3) septic
shock
(4)
platelet count < 150,000 per µL
(5) > 5%
bands in the peripheral blood differential count
(6) age
> 65 years
(7) lower
respiratory tract infection
(8) nursing
home resident
(9) altered
mental state
|
Parameter |
Finding |
Points |
|
terminal illness |
absent |
0 |
|
|
present |
6 |
|
tachypnea or hypoxia |
respiratory rate <= 20 breaths per minute and oxygen
saturation >= 90% |
0 |
|
|
respiratory rate > 20 breaths per minute and/or
oxygen saturation <90% |
3 |
|
septic shock |
absent |
0 |
|
|
present |
3 |
|
platelet count |
>= 150,000 per µL |
0 |
|
|
< 150,000 per µL |
3 |
|
percent bands in differential count |
<= 5% |
0 |
|
|
> 5% |
3 |
|
age of the patient |
<= 65 years |
0 |
|
|
> 65 years |
3 |
|
lower respiratory tract infection |
absent |
0 |
|
|
present |
2 |
|
nursing home resident |
no |
0 |
|
|
yes |
2 |
|
mental status |
normal |
0 |
|
|
altered |
2 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 27
• The higher the score, the more seriously ill the
patient.
|
Total Score |
Risk Group |
Mortality
Rate |
|
0 to 4 |
very low |
0.9 –
1.1% |
|
5 to 7 |
low |
2.0 –
4.4% |
|
8 to 11 |
moderate |
7.8 –
9.3% |
|
12 to 15 |
high |
16 –
20% |
|
16 to 27 |
very
high |
39-50% |
Performance:
• The area
under the ROC curve for the derivation set was 0.82 and for the validation set
was 0.78.
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