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Usefulness of the Mortality in Severe Sepsis in the Emergency Department score in an urban tertiary care hospital

Published:March 17, 2016DOI:https://doi.org/10.1016/j.ajem.2016.03.037

      Abstract

      Background

      The Mortality in Severe Sepsis in the Emergency Department (MISSED) score is a newly proposed scoring system. The goal of this study is to determine if the MISSED score is generalizable to an urban tertiary care hospital.

      Methods

      This is a retrospective chart review conducted from July 2012 to June 2014. Inclusion criteria consisted of adult emergency department (ED) patients with severe sepsis, defined as lactate level 4 mmol/L or greater. Demographics, lactate, international normalized ratio (INR), albumin, intensive care unit admission, and ED intubation were analyzed using χ2 test, t test, and logistic regression. The MISSED score was calculated using the variables albumin 27 g/L or less, INR 1.3 or greater, and age 65 years or older and analyzed using the area under the curve. The primary outcome was inhospital mortality.

      Results

      A total of 182 patients met inclusion criteria, and mortality was 32%. Patients in the mortality group had older age (58.1 ± 17.2 vs 62.7 ± 14.7; P = .07), higher lactate (5.9 ± 2.7 vs 7.3 ± 3.1; P < .01), lower albumin (34.3 ± 8.3 vs 25.6 ± 7.1; P < .0001), higher INR (1.4 ± 0.6 vs 2.4 ± 1.9; P < .0001), ED intubation (21% vs 56%; P < .0001), and intensive care unit admission (41% vs 78%; P < .0001). The regression model found that albumin of 27 g/L or less (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.36), INR 1.3 or greater (OR, 8.3; 95% CI, 3.35-20.51), and ED intubation (OR, 5.6; 95% CI, 2.56-12.35) predicted mortality. The area under the curve for the MISSED score was 0.78 (95% CI, 0.73-0.85).

      Conclusion

      The MISSED score is useful for predicting mortality in ED patients with severe sepsis.
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