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

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 st...

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Main Authors: Su-Han Chang, Chiao-Hsuan Hsieh, Yi-Ming Weng, Ming-Shun Hsieh, Zhong Ning Leonard Goh, Hsien-Yi Chen, Tung Chang, Chip-Jin Ng, Joanna Chen-Yeen Seak, Chen-Ken Seak, Chen-June Seak
Format: Article
Language:English
Published: Hindawi Limited 2018-01-01
Series:BioMed Research International
Online Access:http://dx.doi.org/10.1155/2018/6983568
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spelling doaj-c03d1ec55ea94a8b9d94aef3e9161b8b2020-11-25T02:21:55ZengHindawi LimitedBioMed Research International2314-61332314-61412018-01-01201810.1155/2018/69835686983568Performance 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 DepartmentSu-Han Chang0Chiao-Hsuan Hsieh1Yi-Ming Weng2Ming-Shun Hsieh3Zhong Ning Leonard Goh4Hsien-Yi Chen5Tung Chang6Chip-Jin Ng7Joanna Chen-Yeen Seak8Chen-Ken Seak9Chen-June Seak10Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, TaiwanDepartment of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, TaiwanSchool of Medicine, International Medical University, Kuala Lumpur, MalaysiaDepartment of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanDepartment of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanSarawak General Hospital, Kuching, Sarawak, MalaysiaSarawak General Hospital, Kuching, Sarawak, MalaysiaDepartment of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, TaiwanBackground. 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.http://dx.doi.org/10.1155/2018/6983568
collection DOAJ
language English
format Article
sources DOAJ
author Su-Han Chang
Chiao-Hsuan Hsieh
Yi-Ming Weng
Ming-Shun Hsieh
Zhong Ning Leonard Goh
Hsien-Yi Chen
Tung Chang
Chip-Jin Ng
Joanna Chen-Yeen Seak
Chen-Ken Seak
Chen-June Seak
spellingShingle Su-Han Chang
Chiao-Hsuan Hsieh
Yi-Ming Weng
Ming-Shun Hsieh
Zhong Ning Leonard Goh
Hsien-Yi Chen
Tung Chang
Chip-Jin Ng
Joanna Chen-Yeen Seak
Chen-Ken Seak
Chen-June Seak
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
BioMed Research International
author_facet Su-Han Chang
Chiao-Hsuan Hsieh
Yi-Ming Weng
Ming-Shun Hsieh
Zhong Ning Leonard Goh
Hsien-Yi Chen
Tung Chang
Chip-Jin Ng
Joanna Chen-Yeen Seak
Chen-Ken Seak
Chen-June Seak
author_sort Su-Han Chang
title 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
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
publisher Hindawi Limited
series BioMed Research International
issn 2314-6133
2314-6141
publishDate 2018-01-01
description 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.
url http://dx.doi.org/10.1155/2018/6983568
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