Severity scores in emergency department patients with presumed infection: a prospective validation study

Williams, Julian M., Greenslade, Jaimi H., Chu, Kevin, Brown, Anthony F. T. and Lipman, Jeffrey (2016) Severity scores in emergency department patients with presumed infection: a prospective validation study. Critical Care Medicine, 44 3: 539-547. doi:10.1097/CCM.0000000000001427


Author Williams, Julian M.
Greenslade, Jaimi H.
Chu, Kevin
Brown, Anthony F. T.
Lipman, Jeffrey
Title Severity scores in emergency department patients with presumed infection: a prospective validation study
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 1530-0293
0090-3493
Publication date 2016-03-01
Year available 2016
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000001427
Open Access Status Not Open Access
Volume 44
Issue 3
Start page 539
End page 547
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Collection year 2017
Language eng
Formatted abstract
Objectives: The objectives of this study were to 1) validate a number of severity of illness scores in a large cohort of emergency department patients admitted with presumed infection and 2) compare the performance of scores in patient subgroups with increasing mortality: infection without systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock.

Design: Prospective, observational study.

Setting: Adult emergency department in a metropolitan tertiary, university-affiliated hospital.

Patients: Emergency department patients admitted with presumed infection.

Interventions: None.

Methods: Consecutive emergency department patients admitted with presumed infection were identified over 160 weeks in two periods between 2007 and 2011. Clinical and laboratory data sufficient to calculate Mortality in Emergency Department Sepsis score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and the Severe Sepsis Score were entered into a database. Model discrimination was quantified using area under the receiver operating curve. Calibration was assessed using visual plots, Hosmer-Lemeshow statistics, and linear regressions of observed and predicted values.

Measurements and Main Results: A total of 8,871 patients were enrolled with 30-day mortality of 3.7%. Area under the receiver operating curve values for the entire cohort were: Mortality in Emergency Department Sepsis score of 0.92, Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation II scores of 0.90, Sequential Organ Failure Assessment score of 0.86, and Severe Sepsis Score of 0.82. Discrimination decreased in subgroups with greater mortality for each score. All scores overestimated mortality, but closest concordance between predicted and observed mortality was seen with Mortality in Emergency Department Sepsis score.

Conclusions: The decrease in area under the receiver operating curve seen in subgroups with increasing mortality may explain some variation in results seen in previous validation studies. Scores developed in intensive care settings overestimated mortality in the emergency department. Our results underscore the importance of employing predictive models developed in similar patient populations. The Mortality in Emergency Department Sepsis score outperformed more complex predictive models and would be the most appropriate scoring system for use in similar emergency department populations with a wide spectrum of mortality risk.
Keyword Emergency department
Mortality
Depsis
Deverity of illness index
Validation studies
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Admin Only - School of Medicine
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 2 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 15 Mar 2016, 00:38:02 EST by System User on behalf of School of Medicine