Rapid Emergency Medicine score: a new prognostic tool for in‐hospital mortality in nonsurgical emergency department patients

Abstract.

Objectives. To evaluate the predictive accuracy of the scoring system Rapid Acute Physiology score (RAPS) in nonsurgical patients attending the emergency department (ED) regarding in‐hospital mortality and length of stay in hospital (LOS), and to investigate whether the predictive ability of RAPS could be improved by extending the system.

Design. Prospective cohort study.

Setting. An adult ED of a 1200‐bed university hospital.

Subjects. A total of 12 006 nonsurgical patients presenting to the ED during 12 consecutive months.

Methods. For all entries to the ED, RAPS (including blood pressure, respiratory rate, pulse rate and Glasgow coma scale) was calculated. The RAPS system was extended by including the peripheral oxygen saturation and patient age (Rapid Emergency Medicine score, REMS) and this new score was calculated for each patient. The statistical associations between the two scoring systems and in‐hospital mortality as well as LOS in hospital were examined.

Results. The REMS was superior to RAPS in predicting in‐hospital mortality [area under receiver operating characteristic (ROC) curve 0.852 ± 0.014 SEM for REMS compared with 0.652 ± 0.019 for RAPS, P < 0.05]. An increase of 1‐point in the 26‐point REMS scale was associated with an OR of 1.40 for in‐hospital death (95% CI: 1.36–1.45, P < 0.0001). Similar results were obtained in the major patient groups (chest pain, stroke, coma, dyspnoea and diabetes), in all age groups and in both sexes. The association between REMS and LOS was modest (r = 0.47, P = 0.0001).

Conclusions. The REMS was a powerful predictor of in‐hospital mortality in patients attending the ED over a wide range of common nonsurgical disorders.

Rapid Emergency Medicine score_ a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients למאמר בPDF

2 תגובות

  1. Pinchas Halpern

    המאמר הוא מ 2004!! זה באמת החידוש האחרון בתחום?

  2. airdoc

    מצאתי מאמר חדש מ 2017 אבל על טראומה במלר”ד

    The modified rapid emergency medicine score: A novel trauma triage tool to predict in-hospital mortality.
    Miller RT1, Nazir N2, McDonald T3, Cannon CM4.
    Author information
    Abstract
    BACKGROUND:
    Trauma systems currently rely on imperfect and subjective tools to prioritize responses and resources, thus there is a critical need to develop a more accurate trauma severity score. Our objective was to modify the Rapid Emergency Medicine (REMS) Score for the trauma population and test its accuracy as a predictor of in-hospital mortality when compared to other currently used scores, including the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the “Mechanism, Glasgow Coma Scale, Age and Arterial Pressure” (MGAP) score, and the Shock Index (SI) score.

    METHODS:
    The two-part study design involved both a modification step and a validation step. The first step incorporated a retrospective analysis of a local trauma database (3680 patients) where three components of REMS were modified to more accurately represent the trauma population. Using clinical judgment and goodness-of-fit tests, systolic blood pressure was substituted for mean arterial pressure, the weighting of age was reduced, and the weighting of Glasgow Coma Scale was increased. The second part comprised validating the new modified REMS (mREMS) score retrospectively on a U.S. National Trauma Databank (NTDB) that included 429,711 patients admitted with trauma in 2012. The discriminate power of mREMS was compared to other trauma scores using the area under the receiver operating characteristic (AUC) curve.

    RESULTS:
    Overall the mREMS score with an AUC of 0.967 (95% CI: 0.963-0.971) was demonstrated to be higher than RTS (AUC 0.959 [95% CI: 0.955-0.964]), ISS (AUC 0.780 [95% CI 0.770-0.791]), MGAP (AUC 0.964 [95% CI: 0.959-0.968]), and SI (AUC 0.670 [95% CI: 0.650-0.690]) in predicting in-hospital mortality on the NTDB.

    CONCLUSION:
    In the trauma population, mREMS is an accurate predictor of in-hospital mortality, outperforming other used scores. Simple and objective, mREMS may hold value in the pre-hospital and emergency department setting in order to guide trauma team responses.

    Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

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