A comparison of severity of illness scoring system for emergency department patients with systemic inflammatory response syndrome

Abstract

To evaluate the predictive ability of 3 scoring systems, i.e. acute physiology and chronic health evaluation II (APACHE II) score, simplified acute physiology score II (SAPS II) and mortality in emergency department sepsis (MEDS) score in patients presenting systemic inflammatory response syndrome (SIRS) in emergency department. Six hundred and twenty-one adult patients with SIRS admitted from December 2006 to September 2007 in the emergency department of Beijing Chaoyang Hospital were eligible for the study. The first 24-hour admission data necessary for the calculation of APACHE II score, SAPS II score, MEDS score and basic demographic statistics were collected and the outcomes in 28 days were recorded. Logistic regression analysis was used to determine the independent predictors for 28-day mortality. Discrimination of each scoring system was assessed with the areas under the receiver operating characteristics (ROC) curve (AUC). A total of 222 patients died in 28 days in a total of 621 patients. The age and mean levels of 3 scoring systems were predominantly higher in nonsurvivors than survivors (73 years vs. 70 years for age, P<0.05; 18 vs. 14 for APACHE II score, P<0.01; 36 vs. 24 for SAPS II score, P<0.01; 14 vs. 7 for MEDS score, P<0.01). The independent predictors of 28-day mortality were APACHE II score, SAPS II score and MEDS score. The AUCs were 0.715, 0.774 and 0.965 for APACHE II score, SAPS II score and MEDS score, respectively. There was significant difference between MEDS score and APACHE II score in AUC (Z=35.435, P<0.01). In emergency department patients with SIRS, the MEDS score possesses more predictive ability than APACHE II score.