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| Comparison of NEWS, MEWS and MEDS scores for predicting mortality in emergency department patients with infection |
| Song Lin-lin, Wang Yan, Zhang Xiang-yang, Feng Li-li, Wang Yi-qun, Gong Xiao-jie, Chen Xin-pei, Zhao Xin-liang, Chen Xu-yan |
| Department of Critical Emergency, Beijing Tsing-hua Changgung Hospital, Beijing 102218, China |
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Abstract Objective To investigate the value of national early warning score (NEWS), modified early warning score (MEWS) and mortality in emergency department sepsis score (MEDS) in predicting the outcome of patients with infection in emergency department (ED), and to explore a new scoring method. Methods A total of 215 patients with infection treated in the ED of Beijing Tsing-hua Changgung Hospital from January 2016 to August 2016 were enrolled retrospectively. Gender, age, comorbidities, vital signs, infection sites and laboratory testing results were collected. The 28-day outcome of survival or death was considered as the end point of the study. NEWS, MEWS and MEDS were compared respectively between non-survivors and survivors. Logistic regression analysis was used to determine the independent predictors for 28-day mortality, then was fitted to equation. Area under the receiver operating characteristics (ROC) curve was used to evaluate the value of these scores and equation in predicting 28-day death. Results Among these 215 patients, the mortality rate within 28 days after admission was 14.88%. It was identified by Logistic regression that age, history of malignant tumor, heart rate(HR), respiration rate, systolic blood pressure, SpO2, platelet count, hematocrit, serum creatinine, estimated glomerular filtration rate (eGFR) were significantly independent factors in 28-day death prediction (P＜0.05). Area under the ROC curve for 28-day mortality were 0.881, 0.757, 0.935, 0.954 for NEWS, MEWS, MEDS and equation (P＜0.05). The comparison between NEWS and MEDS had not shown statistical significance (P>0.05), but the significance was illustrated when compared NEWS with MEWS (P＜0.01). To explore a new scoring method, equation was deduced with HR and serum creatinine and was shown to have the best sensitivity, and its area under the ROC curve was greater than MEWS (P＜0.01) and NEWS (P＜0.05). Conclusion MEDS is a good prognosis predictive tool for emergency patients with infection, its prognostic performance is as good as NEWS, but better than MEWS. Combined MEDS score with HR and serum creatinine gives the greatest prognostic power in comparison with NEWS and MEWS scores.
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Corresponding Authors:
Chen Xu-yan, E-mail： 18601307289@163.com
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