Half of the patients with sepsis arrive at the ED by EMS. These patients are seriously ill, and although these patients are likely to benefit from early treatment, they are often transported with nonurgent rides and both assessment of vital signs and early start of treatment are not routinely performed.

The MEDS and CURB-65 scores are the most adequate and feasible tools for the prediction of total 28-day mortality in septic patients presenting at the ED, but they need local recalibration before use in the ED.

Ambulance patients are seriously ill, but sepsis is often not documented by ambulance staff. Nondocumentation is associated with high mortality and could be resolved by assessing vital signs, particularly the temperature.

BackgroundSepsis 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).MethodsIn 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.ResultsBoth 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.ConclusionBoth 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-015-0056-z) contains supplementary material, which is available to authorized users.

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