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
Open Access
- 19 September 2018
- journal article
- research article
- Published by Hindawi Limited in BioMed Research International
- Vol. 2018, 1-8
- https://doi.org/10.1155/2018/6983568
Abstract
Background. Renal abscess is a relatively uncommon yet debilitating and potentially fatal disease. There is no clearly defined, objective risk stratification tool available for emergency physicians’ and surgeons’ use in the emergency department (ED) to quickly determine the appropriate management strategy for these patients, despite early intervention having a beneficial impact on survival outcomes. Objective. This case control study evaluates 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) in predicting risk of mortality in ED adult patients with renal abscess. This will help emergency physicians, surgeons, and intensivists expedite the time-sensitive decision-making process. Methods. Data from 152 adult patients admitted to the EDs of two training and research hospitals who had undergone a contrast-enhanced computed tomography scan of the abdomen and was diagnosed with renal abscess from January 2011 to December 2015 were analyzed, with the corresponding MEDS, MEWS, REMS, RAPS, and mortality risks calculated. Ability to predict patient mortality was assessed via receiver operating curve analysis and calibration analysis. Results. MEDS was found to be the best performing physiologic scoring system, with sensitivity, specificity, and accuracy of 87.50%, 88.89%, and 88.82%, respectively. Area under receiver operating characteristic curve (AUROC) value was 0.9440, and negative predictive value was 99.22% with a cutoff of 9 points. Conclusion. Our study is the largest of its kind in examining ED patients with renal abscess. MEDS has been demonstrated to be superior to MEWS, REMS, and RAPS in predicting mortality for this patient population. We recommend its use for evaluation of disease severity and risk stratification in these patients, to expedite identification of critically ill patients requiring urgent intervention.Keywords
Funding Information
- Chang Gung Memorial Hospital (CORPG3F0931, CLRPG3D0043)
This publication has 32 references indexed in Scilit:
- Perinephric abscessBJU International, 2011
- Prediction of mortality in adult emergency department patients with sepsisEmergency Medicine Journal, 2009
- PROGNOSTIC VALUE OF MORTALITY IN EMERGENCY DEPARTMENT SEPSIS SCORE, PROCALCITONIN, AND C-REACTIVE PROTEIN IN PATIENTS WITH SEPSIS AT THE EMERGENCY DEPARTMENTShock, 2008
- Performance of Severity of Illness Scoring Systems in Emergency Department Patients with InfectionAcademic Emergency Medicine, 2007
- Performance of Severity of Illness Scoring Systems in Emergency Department Patients with InfectionAcademic Emergency Medicine, 2007
- Prediction of mortality among emergency medical admissionsEmergency Medicine Journal, 2006
- RENAL AND PERIRENAL ABSCESSES IN PATIENTS WITH OTHERWISE ANATOMICALLY NORMAL URINARY TRACTSJournal of Urology, 2004
- Comparison of the Rapid Emergency Medicine Score and APACHE II in Nonsurgical Emergency Department PatientsAcademic Emergency Medicine, 2003
- 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions ConferenceIntensive Care Medicine, 2003
- Current Treatment and Outcomes of Perinephric AbscessesJournal of Urology, 2002