Mortality in Emergency Department Sepsis (MEDS) score predicts 1‐year mortality*

Objective: To assess the predictive performance for 1‐yr mortality of the previously derived and validated Mortality in Emergency Department Sepsis (MEDS) score. Design: Prospective cohort study. Patients: Consecutive adult (aged ≥18 yrs) emergency department patients presenting to an urban, tertiary care, university hospital were eligible if they had a clinically suspected infection as indicated by the decision to obtain a blood culture. The enrollment period was between February 1, 2000, and February 1, 2001. Of 3,926 eligible patient visits, 3,762 (96%) were enrolled and 3,102 unique first visits were analyzed. Interventions: None. Measurements and Main Results: A total of 667 patients (21.5%) died within 1 yr. The unadjusted 1‐yr mortality rates for the MEDS risk groups were: very low risk, 7%; low risk, 20%; moderate risk, 37%; high risk, 64%; very high risk, 80%. Using a Cox proportional hazard model that controlled for age, sex, and Charlson co‐morbidity index, the 1‐yr hazard ratios compared with the baseline very low–risk group were: low risk, 2.2 (1.7–2.9); moderate risk, 3.5 (2.7–4.6); high risk, 6.7 (4.9–9.3); and very high risk, 10.5 (7.2–15.4). The groups were significantly different (p < .0001). Conclusions: Although the score was initially derived for 28‐day in‐hospital mortality, our results indicate that the MEDS score also predicts patient survival at 1 yr after index hospital visit with suspected infection. The score needs external validation before widespread use.

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