External validation of the MISSED score to predict mortality in patients with severe sepsis and septic shock in the emergency department.

OBJECTIVE: The Mortality in Severe Sepsis in the Emergency Department (MISSED) score was derived to predict in-hospital mortality in septic patients in the emergency department (ED). The present study aimed to validate the MISSED score in patients receiving early goal-directed therapy (EGDT).

METHODS: Data were analyzed from 280 patients who received EGDT in a tertiary center ED in Korea. Age 65 years and above, albumin level 27 g/l or less, and international normalized ratio of at least 1.2 were variables included in the MISSED score.

RESULTS: With a cutoff point of 5.5, the odds ratio for death was 2.17 (95% confidence interval 1.18-4.02). Mortality rates with MISSED scores of 0,< 5.5, and ≥ 5.5 were 4.5, 13.4, and 25.2%, respectively. Although the score was less discriminatory in patients who had EGDT commenced in the ED, a MISSED score higher than 5.5 remained significant.

CONCLUSION: Further studies are required to validate the MISSED score in more diverse patients.