Abstract
Background
The Mortality in Severe Sepsis in the Emergency Department (MISSED) score is a newly
proposed scoring system. The goal of this study is to determine if the MISSED score
is generalizable to an urban tertiary care hospital.
Methods
This is a retrospective chart review conducted from July 2012 to June 2014. Inclusion
criteria consisted of adult emergency department (ED) patients with severe sepsis,
defined as lactate level 4 mmol/L or greater. Demographics, lactate, international normalized ratio (INR), albumin,
intensive care unit admission, and ED intubation were analyzed using χ2 test, t test, and logistic regression. The MISSED score was calculated using the variables
albumin 27 g/L or less, INR 1.3 or greater, and age 65 years or older and analyzed using the area under the curve. The primary outcome was
inhospital mortality.
Results
A total of 182 patients met inclusion criteria, and mortality was 32%. Patients in
the mortality group had older age (58.1 ± 17.2 vs 62.7 ± 14.7; P = .07), higher lactate (5.9 ± 2.7 vs 7.3 ± 3.1; P < .01), lower albumin (34.3 ± 8.3 vs 25.6 ± 7.1; P < .0001), higher INR (1.4 ± 0.6 vs 2.4 ± 1.9; P < .0001), ED intubation (21% vs 56%; P < .0001), and intensive care unit admission (41% vs 78%; P < .0001). The regression model found that albumin of 27 g/L or less (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.36), INR 1.3
or greater (OR, 8.3; 95% CI, 3.35-20.51), and ED intubation (OR, 5.6; 95% CI, 2.56-12.35)
predicted mortality. The area under the curve for the MISSED score was 0.78 (95% CI,
0.73-0.85).
Conclusion
The MISSED score is useful for predicting mortality in ED patients with severe sepsis.
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Article Info
Publication History
Published online: March 17, 2016
Accepted:
March 14,
2016
Received in revised form:
March 14,
2016
Received:
December 11,
2015
Footnotes
☆Funding: None.
☆☆Presentations: None.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
