Vorwerk et al modified the Mortality in Emergency Department Sepsis (MEDS) score to evaluate patients presenting with sepsis to the Emergency Department. The authors are from Leicester Royal Infirmary, Leicester General Hospital, Airedale General Hospital and The Prince Charles Hospital in Brisbane.
The change to the original MEDS was removal of the band count. This reduces the maximum score from 27 to 24.
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 (sepsis plus systolic blood pressure < 90 mm Hg despirte a 20-30 mL per kilogram fluid bolus)
(4) platelet count per µL
(5) age in years
(6) lower respiratory tract infection
(7) nursing home resident
(8) altered mental state (referenced to the Glasgow Coma Score)
|
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
|
|
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 (GCS 15)
|
0
|
|
|
altered (GCS < 15)
|
2
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 24
• The higher the score, the more seriously ill the patient.
|
Total Score
|
Risk Group
|
28 Day Mortality
|
|
0 to 4
|
low
|
2%
|
|
5 to 12
|
moderate
|
24%
|
|
13 to 24
|
high
|
59%
|
Performance:
• The area under the ROC curve was 0.82.
• The abbreviated MEDS was superior to the MEWS score and serum lactate for stratifying patients by risk.
