Sivayoham Narani, Holmes Paul, Cecconi Maurizio, Rhodes Andrew
Departments of aEmergency Medicine bIntensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, London, UK.
Eur J Emerg Med. 2015 Oct;22(5):321-6. doi: 10.1097/MEJ.0000000000000176.
The MISSED score was derived and validated in emergency department (ED) patients with sepsis who were admitted to the ICU. This score has now been refined and simplified. The independent variables associated with mortality are age at least 65 years, serum albumin 27 g/l or less, and an international normalized ratio at least 1.3. The simplified MISSED score ranges from 0 to 3 depending on the number of variables present.
The primary objective is to validate the simplified MISSED score for predicting all-cause mortality in the ED population admitted with sepsis. The secondary end-point is to validate the risk stratification for ICU admission.
This is a pragmatic retrospective study of prospectively collected data. ED patients admitted with a diagnosis of sepsis in the year 2012 were studied. Those on warfarin were excluded. The simplified MISSED score was calculated for each patient. The test characteristics for mortality of the simplified MISSED score and the odds ratios of the high-risk groups for the secondary end-point were calculated.
In total, 674 patients, including 65 deaths, were studied. The area under the curve for the simplified MISSED score was 0.74 [95% confidence interval (CI) 0.70-0.77; P<0.0001]. The test characteristics for mortality were as follows: sensitivity 93.9% (95% CI 85-98.3), specificity 37.9% (95% CI 34.1-41.9), positive predictive value 13.9% (95% CI 10.8-17.5), and negative predictive value 98.3% (95% CI 95.7-99.5). The odds ratio for mortality for a score 2 or more was 5.01 (95% CI 2.93-8.57; P<0.0001), and that for ICU admission was 3.00 (95% CI 1.70-5.28; P=0.0001).
The simplified MISSED score could be used to risk stratify septic patients in the ED.
MISSED评分是在入住重症监护病房（ICU）的急诊科（ED）脓毒症患者中得出并验证的。现在该评分已得到完善和简化。与死亡率相关的独立变量为年龄至少65岁、血清白蛋白27g/l或更低以及国际标准化比值至少1.3。简化的MISSED评分根据存在的变量数量在0至3之间。
主要目的是验证简化的MISSED评分对预测因脓毒症入住ED的人群全因死亡率的有效性。次要终点是验证ICU入院的风险分层。
这是一项对前瞻性收集的数据进行的务实回顾性研究。对2012年诊断为脓毒症的ED患者进行了研究。服用华法林的患者被排除。为每位患者计算简化的MISSED评分。计算简化的MISSED评分的死亡率检验特征以及次要终点高危组的比值比。
共研究了674例患者，包括65例死亡患者。简化的MISSED评分的曲线下面积为0.74[95%置信区间（CI）0.70 - 0.77；P<0.0001]。死亡率的检验特征如下：敏感性93.9%（95%CI 85 - 98.3），特异性37.9%（95%CI 34.1 - 41.9），阳性预测值13.9%（95%CI 10.8 - 17.5），阴性预测值98.3%（95%CI 95.7 - 99.5）。评分2分及以上的死亡率比值比为5.01（95%CI 2.93 - 8.57；P<0.0001），ICU入院的比值比为3.00（95%CI 1.70 - 5.28；P = 0.0001）。
简化的MISSED评分可用于对ED中的脓毒症患者进行风险分层。
