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

ObjectiveThe 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).MethodsData 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.ResultsWith 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.ConclusionFurther studies are required to validate the MISSED score in more diverse patients.