Sepsis patient evaluation emergency department (SPEED) score & mortality in emergency department sepsis (MEDS) score in predicting 28-day mortality of emergency sepsis patients

Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.

Efficacy and significance of various scores for pneumonia severity in the management of patients with community-acquired pneumonia in China

Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients.