Risk stratification by abbMEDS and CURB-65 in relation to treatment and clinical disposition of the septic XXXX at the emergency department: a cohort study.

@entity1 @entity497 @entity295 @entity2613
BACKGROUND: @entity295 leads to high mortality, therefore risk stratification is important. The abbMEDS (abbreviated Mortality Emergency Department @entity295 ) score assesses @entity295 severity and predicts mortality. In @entity497 , 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 @entity295 @entity1 at the @entity2613 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 @entity295 @entity1 at the @entity2613 . 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 @entity1 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 @entity2613 @entity1 . 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 @entity2613 may improve @entity295 care when its value as a decision support tool can be confirmed.
