Performance of severity of illness scoring systems in emergency department patients with infection
Performance of severity of illness scoring systems in emergency department patients with infection
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DOI：
10.1197/j.aem.2007.02.036
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发表时间：
2007-08-01
影响因子：
4.4
通讯作者：
Shapiro, Nathan I.
中科院分区：
文献类型：
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作者：
Howell, Michael D.;Donnino, Michael W.;Shapiro, Nathan I.
目的：验证急诊科败血症死亡率（MEDS）评分、意识模糊、尿素氮、呼吸频率、血压、65岁及以上（CURB-65）评分和改良快速急诊医学评分（mREMS）在疑似感染患者中的作用。2003年12月10日至2004年9月30日期间在城市急诊科住院的临床疑似感染成人患者（年就诊量约为50，000例）符合条件。按照最初描述计算MEDS和CURB-65评分，但由于完整的格拉斯哥昏迷量表评分不统一，因此在神经系统评分中修改了REMS。结果：在2,132例患者中，3.9%（95%可信区间[CI] = 3.1%~ 4.7%）的患者死亡。按MEDS评分分层的死亡率如下：0-4分，0.4%（95% CI = 0.0 - 0.7%）; 5-7分，3.3%（95% CI = 1.7%至4.9%）; 8-12分，6.6%（95% CI = 4.4%至8.8%）;以及>= 13分，31.6%（95% CI = 22.4%至40.8%）。按CURB-65分层的死亡率如下：0分，0%（0/457例患者）; 1分，1.6%（95% CI = 0.6%-2.6%）; 2分，4.1%（95% CI = 2.3%-6.0%）; 3分，4.9%（95% CI = 2.8%-6.9%）; 4分，18.1%（95% CI = 11.9%-24.3%）; 5分，28.0%（95% CI = 10.4%-45.6%）。按mREMS分层的死亡率如下：0-2分，0.6%（95%CI = 0至1.2%）; 3-5分，2.0%（95% CI = 0.8%-3.1%）; 6-8分，2.3%（95% CI = 1.1%至3.5%）; 9-11分，7.1%（95% CI = 4.2%至10.1%）; 12-14点，20.0%（95% CI = 12.5%至27.5%）;以及≥ 15点，40.0%（95% CI = 22.5%至57.5%）。MEDS、mREMS和CURB-65的AUC分别为0.85、0.80和0.79.Conclusions：在这个临床疑似感染的大型患者队列中，MEDS、mREMS和CURB-65均与28天住院死亡率相关。
Objectives: To validate the Mortality in Emergency Department Sepsis (MEDS) score, the Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older (CURB-65) score, and a modified Rapid Emergency Medicine Score (mREMS) in patients with suspected infection.Methods: This was a prospective cohort study. Adult patients with clinically suspected infection admitted from December 10, 2003, to September 30, 2004, in an urban emergency department with approximately 50,000 annual visits were eligible. The MEDS and CURB-65 scores were calculated as originally described, but REMS was modified in neurologic scoring because a full Glasgow Coma Scale score was not uniformly available. Discrimination of each score was assessed with the area under the receiver operating characteristics curve (AUC).Results: Of 2,132 patients, 3.9% (95% confidence interval [Cl] = 3.1% to 4.7%) died. Mortality stratified by the MEDS score was as follows: 0-4 points, 0.4% (95% Cl = 0.0 to 0.7%); 5-7 points, 3.3% (95% Cl = 1.7% to 4.9%); 8-12 points, 6.6% (95% Cl = 4.4% to 8.8%); and >= 13 points, 31.6% (95% Cl = 22.4% to 40.8%). Mortality stratified by CURB-65 was as follows: 0 points, 0% (0 of 457 patients); 1 point, 1.6% (95% Cl = 0.6% to 2.6%); 2 points, 4.1% (95% Cl = 2.3% to 6.0%); 3 points, 4.9% (95% Cl = 2.8% to 6.9%); 4 points, 18.1% (95% Cl = 11.9% to 24.3%); and 5 points, 28.0% (95% Cl = 10.4% to 45.6%). Mortality stratified by the mREMS was as follows: 0-2 points, 0.6% (95% Cl = 0 to 1.2%); 3-5 points, 2.0% (95% Cl = 0.8% to 3.1%); 6-8 points, 2.3% (95% Cl = 1.1% to 3.5%); 9-11 points, 7.1% (95% Cl = 4.2% to 10.1%); 12-14 points, 20.0% (95% Cl = 12.5% to 27.5%); and >= 15 points, 40.0% (95% Cl = 22.5% to 57.5%). The AUCs were 0.85, 0.80, and 0.79 for MEDS, mREMS, and CURB-65, respectively.Conclusions: In this large cohort of patients with clinically suspected infection, MEDS, mREMS, and CURB-65 all correlated well with 28-day in-hospital mortality.ACADEMIC EMERGENCY MEDICINE 2007; 14:709-714 (c) 2007 by the Society for Academic Emergency Medicine.