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首页> 外文期刊>BMC Emergency Medicine >Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic patient at the emergency department: a cohort study
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Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic patient at the emergency department: a cohort study

机译：abbMEDS和CURB-65在脓毒症患者急诊科的治疗和临床处置方面的风险分层：一项队列研究

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Background Sepsis leads to high mortality, therefore risk stratification is important. The abbMEDS (abbreviated Mortality Emergency Department Sepsis) score assesses sepsis severity and predicts mortality. In community-acquired pneumonia, the CURB-65 (Confusion, Urea, Respiration, Blood pressure, Age) also provides support in clinical decisions regarding antibiotic treatment and clinical disposition. We investigated the predictive value and feasibility of the abbMEDS and CURB-65 in sepsis patients at the ED and the relationship between the scores and antibiotic treatment and clinical disposition (i.e. admission and type of ward). Methods In this retrospective cohort study, we included 725 sepsis patients at the ED. We investigated the value in predicting 28-day mortality and feasibility of both scores. We calibrated the abbMEDS. We further assessed the relationship between the three risk categories per score and antibiotic treatment (i.e. oral and intravenous narrow or broad-spectrum) and clinical disposition. Results Both abbMEDS and CURB-65 were good predictors of 28-day mortality (13.0 %) (AUC 0.77 [95 % CI 0.72 – 0.83] and 0.73 [95 % CI 0.67 - 0.78], respectively) and feasible (complete score 92.7 and 93.9 %, respectively). In the high risk category of the abbMEDS, all patients were admitted and treated with intravenous broad-spectrum antibiotics. In the high risk category of the CURB-65, 2.5 % were not admitted and 4.4 % received no antibiotics. Conclusion Both abbMEDS and CURB-65 are good predictors of 28-day mortality in septic ED patients. The abbMEDS is well calibrated and matches current clinical decisions concerning antibiotic treatment and clinical disposition, while this is less so for the CURB-65. In the future, use of the abbMEDS at the ED may improve sepsis care when its value as a decision support tool can be confirmed.
机译：背景败血症导致高死亡率，因此危险分层很重要。 abbMEDS（死亡率急诊部门败血症的简称）评分可评估败血症的严重程度并预测死亡率。在社区获得性肺炎中，CURB-65（精神错乱，尿素，呼吸，血压，年龄）也为有关抗生素治疗和临床处置的临床决策提供了支持。我们研究了急诊败血症患者中abbMEDS和CURB-65的预测价值和可行性，以及评分与抗生素治疗和临床处置（即入院和病房类型）之间的关系。方法在这项回顾性队列研究中，我们纳入了725名急诊败血症患者。我们调查了预测两个分数的28天死亡率和可行性的价值。我们校准了abbMEDS。我们进一步评估了每种评分的三种风险类别与抗生素治疗（即口服和静脉内窄或广谱）和临床处置之间的关系。结果abbMEDS和CURB-65都是28天死亡率（13.0％）（AUC 0.77 [95％CI 0.72 – 0.83]和0.73 [95％CI 0.67-0.78]的良好预测）且可行（完整评分为92.7和0.92）。分别为93.9％）。在abbMEDS的高风险类别中，所有患者均入院并接受静脉内广谱抗生素治疗。在CURB-65的高风险类别中，未接受2.5％的患者入院，未接受抗生素的4.4％。结论abbMEDS和CURB-65都是败血症ED患者28天死亡率的良好预测指标。 abbMEDS经过了良好的校准，可以与当前有关抗生素治疗和临床处置的临床决策相匹配，而对于CURB-65则不然。将来，当可以确定其作为决策支持工具的价值时，在急诊室使用abbMEDS可能会改善败血症护理。

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