Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department

Abstract

BackgroundSplenic abscess is rare but has mortality rates as high as 14% even with recent improvements in management. Early and appropriate intervention may improve patient outcomes, yet at present there is no identified method that can predict mortality risk rapidly and accurately for emergency physicians, surgeons, and intensivists to decide on the ideal course of action.ObjectiveThis study aims to evaluate the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) for predicting the mortality risk of adult splenic abscess patients. This will expedite decision making in the emergency department (ED) to increase survival rates and help avoid unnecessary splenectomies.MethodsData of 114 adult patients admitted to the EDs of 4 research and training hospitals who had undergone an abdominal contrast CT scan and diagnosed with splenic abscess between Jan 2000 and April 2015 were analyzed. The MEDS, MEWS, REMS, and RAPS and their corresponding mortality risks were calculated, with their abilities to predict patient mortality assessed through receiver operating characteristic curve analysis and calibration analysis.ResultsMEDS was found to be the best performing scoring system across all indicators, with sensitivity, specificity, and accuracy of 92.86%, 88.00%, and 88.60% respectively; its area under curve for AUROC analysis was 0.92. With a cutoff value of 8, negative predictive value of MEDS was 98.88%.ConclusionOur series is the largest multicenter study in adult ED patients with splenic abscess. The results from the present study show that MEDS is superior to MEWS, REMS and RAPS in predicting mortality, thus allowing earlier detection of critically ill adult ED splenic abscess patients. Therefore, we recommend that MEDS be used for predicting severity of illness and risk stratification in these patients.

Prognostic Value of Three Rapid Scoring Scales and Combined Score for the Assessment of Patients with Coronavirus Disease 2019

“…This scale includes four parameters: blood pressure, pulse, respiratory frequency, and Glasgow coma scale (GCS) score. [24][25][26]. However, the predictive ability of the RAPS differs among disease types.…”

Performance Assessment of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score, and Rapid Acute Physiology Score in Predicting Survival Outcomes of Adult Renal Abscess Patients in the Emergency Department

“…MEDS has also been demonstrated to be a good predictor of prognosis in patients with other intra-abdominal infections [19, 21, 22] and even performs better than other more established risk assessment tools including APACHE II and quick Sepsis-related Organ Failure Assessment in determining mortality risk of ED patients in infection and/or sepsis [23–30]. Its superiority in this study provides further evidence that both clinical presentation and patient characteristics are significant in assessing mortality risk of patients with abdominal infections as mentioned in our introduction, almost half of the 9 criteria in MEDS (age, nursing home resident, terminal illness, altered mental status) are dependent on the patient's medical history that is easily and quickly ascertainable in the ED.…”

“…Statistical analysis results demonstrated that MEDS was superior to MEWS, REMS, and RAPS, thus giving merit to the hypothesis that patient characteristics should also be considered in patients with abdominal infections. We were however surprised to note that the performance of REMS in predicting mortality of splenic abscess patients was ranked last [19]. …”

Perbedaan Glasgow Coma Scale dan Rapid Emergency Medicine Score dalam Memprediksi Outcome Pasien Trauma Kepala di Instalasi Gawat Darurat

“…Najafi, Zakeri, & Mirhaghi (2018) juga meneliti scoring REMS untuk prediksi outcome pada populasi trauma menemukan nilai AUC 0,92 atau performa sangat baik. Nilai ini berbeda dari penelitian Hung, et al (2017)yang menyebutkan prediksi mortalitas pasien sepsis di IGD mendapatkan AUC sebesar 0,67 atau performa cukup.…”

“…Nilai cut of point optimal >5 (risiko sedang) digunakan untuk memprediksi outcome pasien trauma kepala di IGD dengan sensitivitas 61,38%, spesifisitas, 77,78%. Hasil ini tidak jauh berbeda dari hasil penelitian oleh Park, et al (2017) yang memperoleh cut off point optimal 7 (risiko sedang) dengan sensitivitas 84,4%, spesifisitas 77,3%, juga Hung, et al (2017) memperoleh nilai cut off point optimal 7 (risiko sedang) dengan sensitivitas 64,29%, spesifisitas 72%. Adanya kemiripan nilai cut off point optimal yang diduga skor awal berisiko dan berdampak pada outcome yang buruk ini menunjukkan bahwa parameter REMS mampu memprediksi outcome pasien trauma kepala pada semua penelitian.…”