Usefulness of the Mortality in Severe Sepsis in the Emergency Department score in an urban tertiary care hospital

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.