Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments

Abstract

IntroductionDue to the increasing burden on hospital systems, most elderly patients with non-surgical sepsis are admitted to general internal medicine departments. Disease-severity scoring systems are used for stratification of patients for utilization management, performance assessment, and clinical research. Some widely used scoring systems for septic patients are inappropriate when rating non-surgical patients in a non-intensive care unit (ICU) environment mainly because their calculations require types of data that are frequently unavailable. This study aimed to assess the fitness of four scoring systems for septic patients hospitalized in general internal medicine departments: modified early warning score (MEWS), simple clinical score (SCS), mortality in emergency department sepsis (MEDS) score, and rapid emergency medicine score (REMS).MethodsWe prospectively collected computerized data of septic patients admitted to general internal medicine departments in our community-based university hospital. We followed 28-day in-hospital mortality, overall in-hospital mortality, and 30- and 60-day mortality. Using a logistic regression procedure we calculated the area under ROC curve (AUC) for every scoring system.ResultsBetween February 1st, 2008 and April 30th, 2009 we gathered data of 1,072 patients meeting sepsis criteria on admission to general internal medicine departments. The 28-day mortality was 19.4%. The AUC for the MEWS was 0.65-0.70, for the SCS 0.76-0.79, for the MEDS 0.73-0.75, and for the REMS, 0.74-0.79. Using Hosmer-Lemeshow statistics, a lack of fit was found for the MEDS model. All scoring systems performed better than calculations based on sepsis severity.ConclusionsThe SCS and REMS are the most appropriate clinical scores to predict the mortality of patients with sepsis in general internal medicine departments.

A Newly Established Severity Scoring System in Predicting the Prognosis of Patients with Severe Fever with Thrombocytopenia Syndrome

“…Based on the methods mentioned in the references, we included parameters such as pulse (bpm), breathing rate (bpm), systolic pressure (mmHg), Glasgow Coma Scale (GCS), age and blood oxygen saturation (%) (Ghanem-Zoubi et al 2011) in REMS. The acute physiology and chronic health evaluation scoring system (APACHE II) (Malone et al 2001) was consisted of acute physiology score, age score, chronic health evaluation score and the score with three scores in total.…”

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

“…Penelitian lain oleh Ghanem, dkk. 25 pada populasi pasien dengan sepsis menunjukkan performa kalibrasi REMS yang baik untuk memprediksi mortalitas selama perawatan (p=0,75).…”

“…Pada populasi pasien dengan sepsis, penelitian Ghanem, dkk. 25 juga menunjukkan performa diskriminasi REMS baik dengan AUC 0,77 (IK 95%; 0,73-0,80).…”

Complexity Science to Conceptualize Health and Disease: Is It Relevant to Clinical Medicine?

“…For example, odds of acute kidney injury in noncritically ill adult patients are significantly higher (PϽ.001; odds ratio, 3.5) with 2 or more comorbidities than without such comorbidities, and prognostic scoring systems for sepsis suggest that involvement in more than one organ system carries a poorer prognosis. 27,28 Interventions to change a CAS (with its numerous subsystems) ought to be multipronged and act on the different subsystems. The threshold for these multiple interventions ought to be lower than conventional criteria.…”