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. 2015 Oct 13:15:29.
doi: 10.1186/s12873-015-0056-z.

Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic patient at the emergency department: a cohort study

Asselina A Roest  1 , Jan Tegtmeier  2 , Joris J Heyligen  3 , Jeanette Duijst  4 , Andrea Peeters  5 , Hella F Borggreve  6 , Astrid M L Oude Lashof  7 , Coen D A Stehouwer  8   9 , Patricia M Stassen  10   11
Affiliations

Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic patient at the emergency department: a cohort study

Asselina A Roest et al. BMC Emerg Med. .

Abstract

Background: Sepsis leads to high mortality, therefore risk stratification is important. The abbMEDS (abbreviated Mortality Emergency Department Sepsis) score assesses sepsis severity and predicts mortality. In community-acquired pneumonia, the CURB-65 (Confusion, Urea, Respiration, Blood pressure, Age) also provides support in clinical decisions regarding antibiotic treatment and clinical disposition. We investigated the predictive value and feasibility of the abbMEDS and CURB-65 in sepsis patients at the ED and the relationship between the scores and antibiotic treatment and clinical disposition (i.e. admission and type of ward).

Methods: In this retrospective cohort study, we included 725 sepsis patients at the ED. We investigated the value in predicting 28-day mortality and feasibility of both scores. We calibrated the abbMEDS. We further assessed the relationship between the three risk categories per score and antibiotic treatment (i.e. oral and intravenous narrow or broad-spectrum) and clinical disposition.

Results: Both abbMEDS and CURB-65 were good predictors of 28-day mortality (13.0%) (AUC 0.77 [95% CI 0.72 - 0.83] and 0.73 [95% CI 0.67 - 0.78], respectively) and feasible (complete score 92.7 and 93.9%, respectively). In the high risk category of the abbMEDS, all patients were admitted and treated with intravenous broad-spectrum antibiotics. In the high risk category of the CURB-65, 2.5% were not admitted and 4.4% received no antibiotics.

Conclusion: Both abbMEDS and CURB-65 are good predictors of 28-day mortality in septic ED patients. The abbMEDS is well calibrated and matches current clinical decisions concerning antibiotic treatment and clinical disposition, while this is less so for the CURB-65. In the future, use of the abbMEDS at the ED may improve sepsis care when its value as a decision support tool can be confirmed.

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Figures

Fig. 1
Fig. 1
Flowchart of study population
Fig. 2
Fig. 2
Number of patients and 28-day mortality for the three risk categories of abbMEDS and CURB-65
See this image and copyright information in PMC

References

    1. Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101:1481–3. doi: 10.1378/chest.101.6.1481. - DOI - PubMed
    1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995;273:117–23. doi: 10.1001/jama.1995.03520260039030. - DOI - PubMed
    1. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6. doi: 10.1097/01.CCM.0000050454.01978.3B. - DOI - PubMed
    1. Bakker J, Levi M, van Hout BA, van Gestel A. Sepsis, a complicated syndrome with major medical and social consequences. Ned Tijdschr Geneeskd. 2004;148:975–8. - PubMed
    1. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–82. doi: 10.1136/thorax.58.5.377. - DOI - PMC - PubMed

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