Rapid Emergency Medicine Score Score Research Articles

Accuracy of Rapid Emergency Medicine Score and Sequential Organ Failure Assessment Score in predicting acute paraphenylenediamine poisoning adverse outcomes

Paraphenylenediamine (PPD) is a commonly used xenobiotic in hair dying, causing deleterious outcomes in acute poisoning. Although many epidemiological studies and case reports explained their clinical presentations and fatal consequences, no studies have evaluated the early determinants of adverse outcomes. Therefore, the present study aimed to assess the initial predictors of acute PPD poisoning adverse outcomes, focusing on the discriminatory accuracy of the Rapid Emergency Medicine Score (REMS) and Sequential Organ Failure Assessment (SOFA) score. A retrospective cohort study included all acute PPD-poisoned patients admitted to three Egyptian emergency hospitals from January 2020 to January 2022. Data was gathered on admission, including demographics, toxicological, clinical, scoring systems, and laboratory investigations. Patients were categorized according to their outcomes (mortality and complications). Ninety-seven patients with acute PPD poisoning were included, with a median age of 23 years, female predominance (60.8%), and suicidal intention (95.9%). Out of all patients, 25.77% died, and 43.29% had complicated outcomes. Respiratory failure was the primary cause of fatalities (10.30%), while acute renal failure (38.14%) was a chief cause of complications. The delay time till hospitalization, abnormal electrocardiogram, initial creatine phosphokinase, bicarbonate level, REMS, and SOFA scores were the significant determinants for adverse outcomes. The REMS exhibited the highest odds ratio (OR = 1.91 [95% confidence interval (CI): 1.41–2.60], p < 0.001) and had the best discriminatory power with the area under the curve (AUC) = 0.918 and overall accuracy of 91.8% in predicting mortality. However, the SOFA score had the highest odds ratio (OR = 4.97 [95% CI: 1.16–21.21], p = 0.001) and only yielded a significant prediction for complicated sequels with AUC = 0.913 and overall accuracy of 84.7%. The REMS is a simple clinical score that accurately predicts mortality, whereas the SOFA score is more practicable for anticipating complications in acute PPD-poisoned patients.

Predicting the 28-Day Mortality of Non-Trauma Patients using REMS and RAPS; a Prognostic Accuracy Study.

Introduction:Various scoring systems have been designed for calculating the mortality risk of patients. This study evaluated the accuracy of Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) in predicting the 28-day mortality of non-trauma patients.Methods:This prospective cross-sectional study was conducted on 1003 adult non-trauma patients, who referred to the emergency department of Imam Khomeini Hospital, Urmia, Iran, in the second half of 2018, using the census sampling. We determined the screening performance characteristics of REMS and RAPS in predicting the 28-day mortality of patients. Results:This study examined 1003 non-trauma patients with a mean age of 61.5±18.05 years (60.6% male). The mean REMS (8.7 ± 3.2 vs. 6.0 ± 3.6; p < 0.001) and RAPS (3.7 ± 2.8 vs. 2.7 ± 2.0; p < 0.001) scores were significantly higher in deceased cases. Sensitivity and specificity of REMS in predicting the risk of non-trauma patients’ mortality were 85.19% (95%CI: 78.05% - 90.71%) and 78.34% (95%CI: 75.45% - 81.04%), respectively. While, the Sensitivity and specificity of RAPS in this regard were 61.39% (95%CI: 53.33% - 69.02%) and 71.12% (95%CI: 67.94% - 74.16%), respectively. The area under the receiver operating characteristic (ROC) curve of REMS and RAPS were 0.72 (95% CI: 0.68 -0.75) and 0.62 (95% CI: 0.56 - 0.65) in predicting the patients’ 28-day mortality, respectively (p = 0.001). Conclusion:The total accuracies of REMS and RAPS in predicting the 28-day mortality of non-trauma patients were in good and poor range, respectively. The screening performance characteristics of REMS were a little better in this regard.

Investigation of the usability of the REMS, RAPS, and MPM II0 scoring systems in the prediction of short-term and long-term mortality in patients presenting to the emergency department triage.

Appropriate triage is an important component of patient management in emergency departments. The risk scoring system used for triage purposes in emergency departments should be obtained quickly and based on parameters directly related to prognosis. To investigate the success of the Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) as triage scoring systems and the Mortality Probability Model (MPM II0) as an intensive care scoring system in identifying critical patients visited to the emergency department (ED) triage and predicting mortality, and to evaluate their superiority over each other, if any. This research was planned as a single-center and prospectively. The data of the study were obtained by screening the medical records of all patients who presented to the ED triage between January 1, 2020 and January 31, 2020. Patients under the age of 18years, those with missing information in their files and pregnant women were not included in the study. Only the patients for whom the REMS, RAPS, and MPM II0 scores could be calculated were included in the sample. After excluding the patients who did not meet the inclusion criteria, the study was completed with 12,210 patients. The mean age of these patients was 44.7 ± 18.7years, and 47.3% were male. The area under the receiver operating characteristics curve values for the prediction of 24-h, 30-day, 90-day, and 180-day mortality were determined as 0.979, 0.921, 0.904, and 0.897, respectively, for REMS; 0.929, 0.778, 0.75, and 0.725, respectively, for RAPS; and 0.925, 0.888, 0.866, and 0.861, respectively, for MPM II0. In this study, it was concluded that the REMS score was superior to the MPM II0 and RAPS scores in predicting the short-term and long-term mortality status of patients and determining the discharge and hospitalization status of the patients.

Comparison of Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for Prediction of Early Mortality in Adult Trauma Patients

Background: Trauma is an injury to living tissue from an external source. The severity of traumatic injuries plays a crucial role in the determination of mortality in patients with trauma, thus a proper understanding of the severity of trauma is very important for improving trauma care. Several scoring systems are available for the objective, initial assessment of the severity of injury to help treatment strategy. Aim of the study was to compare Emergency Trauma Score (EMTRAS) with Rapid Emergency Medicine Score (REMS) for prediction of early mortality in adult trauma patients.&#x0D; Methods: Study was conducted with 100 patients of either sex, age 18 years or above with history of trauma due to road accident, fall and assault. REMS and EMTRAS score was calculated from the laboratory and patient characteristics mentioned in the Trauma scoring datasheet, within 30 minutes of arrival of the patient in the hospital and 24 hours after hospitalization.&#x0D; Results: Comparison of the REMS score within 30 mins of patient arrival and at 24 hrs was statistically significant (p=0.0099). Comparison of EMTRAS SCORE Within 30 mins of patient arrival and at 24 hrs was not statistically significant (p=0.0505). Comparison of REMS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=&lt;0.0001). Comparison of EMTRAS vs Outcome at 24 hrs (Non-Survivors and Survivors) was statistically significant (p=&lt;0.0001). Comparison of AUROC (Area Under the Receiver Operating Characteristics) of REMS and EMTRAS were 0.689 and 0.789 respectively, which was statistically significant.&#x0D; Conclusion: We conclude that both REMS and EMTRAS are easy, accurate predictors of in-hospital early mortality in Adult Trauma Patients. But in our study, EMTRAS AUROC was greater than AUROC of REMS. Hence EMTRAS should have good prognostic power for predicting in-hospital early mortality in Adults Trauma patients.

Physiologic Scoring Systems versus Glasgow Coma Scale in Predicting In-Hospital Mortality of Trauma Patients; a Diagnostic Accuracy Study.

Introduction:In recent years, several scoring systems have been developed to assess the severity of trauma and predict the outcome of trauma patients. This study aimed to compare Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) in predicting the in-hospital mortality of trauma patients.Methods:This diagnostic accuracy study was done on adult patients admitted to the emergency department (ED) between June 21, 2019, and September 21, 2020, following multiple trauma. Patients were followed as long as they were hospitalized. The REMS, MEWS, GCS, and ISS were calculated after data gathering and comprehensive assessment of injuries. Receiver operating characteristics (ROC) analysis was performed to examine the prognostic performance of the four different tools.Results:Of the 754 patients, 32 patients (4.2%) died and 722 (95.8%) survived after 24 hours of admission. The mean age of the patients was 38.54 ± 18.58 years (78.9% male). The area under the ROC curves (AUC) of REMS, MEWS, ISS, and GCS score for predicting in-hospital mortality were 0.942 (95% CI [0.923-0.958]), 0.886 (95% CI [0.861-0.908]), 0.866 (95% CI [0.839-0.889]), and 0.851 (95% CI [0.823-0.876]), respectively. The AUC of REMS was significantly higher than GCS (p=0.035). The sensitivities of GCS ≤ 11, ISS ≥ 13, REMS ≥ 4, and MEWS ≥ 3 scores for in-hospital mortality were 0.56, 0.97, 0.81, and 0.94, respectively. Also, the specificities of GCS, ISS, REMS, and MEWS scores for in-hospital mortality were 0.93, 0.82, 0.81, and 0.85, respectively.Conclusion:It seems that REMS is more accurate than GCS, ISS, and MEWS in predicting in-hospital mortality ≥ 24 hours of multiple trauma patients.

Comparison of different scoring systems in poisoning with cholinesterase inhibitors

Early identification of cholinesterase inhibitor (AChEI) - poisoned patients who are at risk of respiratory insufficiency or death is crucial to initiate proper interventions. The present study aimed to compare Glasgow Coma Scale (GCS), acute physiology and chronic health evaluation (APACHE II), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS) and simple clinical score (SCS) in order to predict the need of mechanical ventilation (MV) and the risk of mortality in AChEIs poisoning. A retrospective study was conducted on 118 patients with acute AChEIs poisoning. The patients’ data were collected from their hospital records. The studied scoring systems were evaluated on admission. Statistical analysis revealed that the median APACHE II, GCS, REMS, RAPS, and SCS differed significantly between MV patients and non-MV as well as between non-survivors and survivors. RAPS and REMS scores showed the highest discriminatory power in prediction of MV and mortality. No significant differences were detected between the studied scores as predictors of MV and mortality except for SCS which was significantly inferior to RAPS and REMS in prediction of MV. In conclusion, the admission REMS or RAPS seem to have valuable prognostic abilities in AChEIs poisoning for identification of patients who require MV or at increased risk of mortality.

Prediction of Mortality in Sepsis using Rapid Emergency Medicine Score: A Cohort Study

Introduction: Organ dysfunction due to sepsis is manifested as acute rise of 2 points in quick Sequential Organ Failure Assessment (qSOFA) score from baseline, which is assessed by: 1) Systolic Blood Pressure (SBP) ≤100 mmHg; 2) Respiration Rate (RR) ≥22/min; 3) altered mentation, each having one point. For timely and specific management, an early diagnosis and stratification of severity of the sepsis is important. To predict the outcome of sepsis many scoring systems like SOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Mortality Prediction Model (MPM) have been developed. REMS is simple and feasible scoring system comprising of simple variables like, age in years, Pulse Rate (PR), RR, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS) and SpO2 estimation. Aim: The aim of the study was to evaluate the efficacy of REMS score and to validate its utility in patients with sepsis to predict mortality. Materials and Methods: This was an observational, cohort study conducted in the Department of Medicine of SCB Medical College and Hospital, Cuttack. A total of 100 patients of sepsis admitted to medical wards and Intensive Care Unit (ICU) of Medicine department were included in the study. Vital parameters like PR, SBP, RR, GCS, SpO2 were noted. REMS score was calculated for patients with sepsis and septic shock, among survivors and non survivors. Primary outcome was either death or discharged. The observed data was statistically analysed for utility of REMS score in predicting mortality, which is the secondary outcome of the study. Student’s t-test and Mann-Whitney U test were used for comparing normally and non-normally distributed data respectively. Univariate and multivariate logistic regression was done for all parameters in REMS. Results: The average age of the patients was 49 years (SD 14.5) with males and females almost equally distributed. Major source of infection were pneumonia (24%) followed by urinary tract infections (19%). REMS score was calculated on the day of admission of all 100 patients. It clearly distinguished survivors from non survivors (p&lt;0.001). The median value of REMS among non survivors was 9 (7-10), which was highly significant compared to survivors; median value of REMS among survivors was 3.5 (2-5). REMS score was high among patients with septic shock than patients with sepsis {median REMS: 9 (7-10.5) vs. 4 (2-5.75); p&lt;0.001}. All the variables in REMS were significantly associated with mortality, however with multivariate analysis only the RR was independent predictor of mortality. REMS at cut-off score 7 has sensitivity of 87.5%, specificity of 88.2%, Positive Predictive Value (PPV) of 70%, Negative Predictive Value (NPV) of 95.7%, and accuracy of REMS was 88%. Conclusion: REMS score showed a significant difference among survivors and non survivors with higher score predicting higher mortality. Hence, REMS is a valid scoring system that can be used in resource limited emergency departments to predict the mortality in patients with sepsis and septic shock.

Risk Factors for Non-optimal Resource Utilization for Emergent Interfacility Transfers by Air Ambulance in Ontario

Background: The use of air ambulance to facilitate interfacility transfer has been associated with improved mortality; however, air ambulance is a limited resource and sometimes the optimal resource to transport a patient is unavailable. When a non-optimal resource is used there is an inherent delay and critically unwell patients may deteriorate as a result. This study aimed to identify risk factors associated with non-optimal resource utilization for adult patients undergoing emergent interfacility transport by air ambulance in Ontario, Canada. A secondary objective was to determine if non-optimal resource utilization was associated with deterioration in clinical status by measuring a delta rapid emergency medicine score (REMS). Methods: This was a retrospective cohort study of all emergent, adult interfacility transfers transported by air ambulance over a 5-year period in Ontario, Canada. Determination of optimal resource use was based on distances and historic time data for all sending-receiving facility pairs. A logistic regression model was used to explore patient, provider and institutional risk factors for non-optimal resource use. To explore the secondary objective a linear regression model was used to explore impact of non-optimal resource use on deltaREMS. Results: There were a total of 9,687 patients included in the study cohort, with 4,984 having an optimal resource use and 4,703 having non-optimal resource. The median delay in interfacility transfer caused by a non-optimal transfer strategy was 35.7 minutes. Patients who required mechanical ventilation (OR 1.13, p = 0.031) and or were transferred out of nursing stations had higher odds of non-optimal resource use (OR 2.84, p = 0.019). Paramedic level of care of advanced (OR 0.37, p = < 0.001) and critical care (OR 0.28, p = < 0.001) as well as spring season (OR 0.75, p = < 0.001) had lower odds of non-optimal resource utilization. Optimal resource utilization did not significantly affect delta REMS (beta coefficient 0.002, p = 0.64). Conclusions: Patients who required mechanical ventilation and were transferred out from a nursing station had higher odds of non-optimal resource utilization while patients that required advanced or critical care level of care and spring season had lower odds of non-optimal resource use. Additionally, non-optimal resource use for air ambulance interfacility transfers did not result in patient deterioration as measured by a delta REMS score.

Assessment of Some Scoring Systems in Prediction of Mortality in Acute Carbon Monoxide Poisoned Patients

Carbon monoxide (CO) is known as a silent killer. In Egypt, it is one of the most common causes of death-related poisonings. This study aimed to evaluate some scoring systems; Glasgow coma scale (GCS), acute physiology and chronic health evaluation II (APACHE II), simplified acute physiology score II (SAPS II) and rapid emergency medicine score (REMS) for predicting in-hospital mortality of patients with acute CO poisoning. One hundred and eight acutely CO poisoned patients were included in the study. For each patient, socio-demographic and toxicological data were recorded. Clinical examination and calculation of the four scoring systems were performed. Patients were divided into two groups; survivors and non-survivors. Discrimination was evaluated using ROC curve and calculating the area under the curve (AUC). The current study revealed that median age of the studied patients was 25.5 years, 55.6% were males and 61.1% were from rural areas. All cases were intoxicated accidently. Among the studied 108 patients; 20 patients died in hospital and 88 patients survived. Both APACHE II and SAPS II had the best AUC, followed by REMS then GCS. The AUC of GCS was significantly lower than those of APACHE II, SAPS II and REMS scores; while differences between AUC of APACHE II, SAPS, and REMS were not statistically significant. It could be concluded that REMS is more useful in predicting in-hospital mortality in acute CO poisoning as it is a simple, easy and rapid scoring system rather than more complicated scoring systems such as APACHE II and SAPS II.

Impact of Non-Optimal Transfer Strategy On Rapid Emergency Medicine Score For Emergent Interfacility Transfers By Air Ambulance In Ontario

Introduction Ornge is the sole air ambulance service in Ontario, Canada and provide interfacility transfers for severely ill patients. Sometimes the closest aircraft or most optimal resource is unavailable resulting in a transport delay. These patients may experience a clinical deterioration as a result. The primary objective of this study is to determine if a non-optimal transfer strategy is associated with a clinical deterioration as measured by a change in Rapid Emergency Medicine Score (REMS) compared to patients with an optimal transfer strategy. The secondary objective was to determine which factors were associated with a non-optimal transfer strategy. Methods This was a retrospective population-based cohort study using a health administrative database looking at all emergent adult interfacility transfers over a 5-year period. All interfacility transfers during that time were analyzed by sending-receiving pair and mean overall transport times calculated for reach unique resource to determine the fastest and most utilized resource for each sending-receiving pair. An optimal transfer strategy was defined by three conditions 1) the resource used was both the fastest and most utilized 2) the fastest fixed-wing resource if distance was greater than 240 km or 3) the fastest rotor-wing resource if distance was less than 240 km. The primary outcome, delta REMS was calculated by subtracting the REMS at time of request from the REMS at time of paramedic arrival. Therefore an increase in delta REMS would correlate with a clinical deterioration of a patient. Descriptive statistics were performed on patient, paramedic, institutional and time-level factors. A generalized linear model was used to determine the effect of transfer strategy on change in REMS score while adjusting for the other variables of interest and accounting for clustering by sending facility. For the secondary outcome a logistic regression model was used to explore factors associated with a non-optimal transfer strategy. Results The final study cohort included 9,687 patients and the median delay in interfacility transfer caused by a non-optimal transfer strategy was 35.7 minutes. Transfer strategy did not significantly affect change in REMS (beta coefficient 0.002; 95% CI: -0.08 - 0.82) in the adjusted linear regression model. The only patient characteristic found to be associated with a change in REMS in both the unadjusted and adjusted analysis was whether the patient was mechanically ventilated. Paramedic level of care of advanced (OR 0.37; 95% CI: 0.22 - 0.63) and critical care (OR 0.28; 95% CI: 0.16 - 0.49) as well as spring season (OR 0.75; 95% CI: 0.66 - 0.84) had lower odds of non-optimal transfer strategy in the generalized logistic regression model. Additionally, nursing stations had higher odds of non-optimal transfer strategy (OR 2.84; 95% CI: 1.19 - 6.83). Conclusion In conclusion, in this study population a non-optimal transfer strategy for air ambulance interfacility transfers did not result in patient deterioration as measured by a change in REMS score. Additionally, decreasing sending facility size was associated with higher odds of non-optimal transfer strategy while patients on a ventilator, requiring advance or critical care level of care and spring season had lower odds of non-optimal transfer strategy.

Evaluation of Various Scoring Systems in Prediction of Acute Aluminum Phosphide (ALP) Poisoning Outcome

Introduction: Aluminum phosphide (Alp) poisoning is a major health problem developing countries because of the high rates of morbidity and mortality even in well-equipped and experienced hospitals.. The aim of this study: Was to evaluate various scoring system (Acute Physiology and Chronic Health Evaluation (APACHE) score, Rapid Emergency Medicine Score (REMS), The Sequential Organ Failure Assessment (SOFA) score) at admission for outcome prediction in acute aluminum phosphide poisoned patients. Patients and methods: The present study is a cohort study that was carried out on acute Alp poisoned patients at Poison Control Unit, Tanta University Emergency Hospital. It was composed of two periods; one year retrospective (from April 2015 to March 2016) and six months prospective (from April 2016 to September 2016).All admitted patients over 16 years with acute aluminum phosphide poisoning were included in this study. Patients were grouped according to their outcome into survivors and non survivors. From the collected data, APACHE II, SOFA and REMS scores were calculated for every patient. Results: The present study was carried out on admitted fifty acute Alp poisoned patients. Out of them, survivors represented 44% and 56% were non-survivors. The majority of patients were in the age group 16-20 years, females, student, from rural areas (90%) and most of patients had ingested phosphides intentionally in a median dosage of one tablet. Hypotension, tachypnea, metabolic acidosis, hyperglycemia and higher serum creatinine levels and alanine transaminase (ALT) at admission, were risk factors of mortality from Alp. Non survivors had significantly higher APACHE II, SOFA and REMS score values than survivors. SOFA score had the best AUC (0.989) followed by APACHE II score then REMS score (0.987 and 0.970 respectively). However, no significant differences between AUC values of compared scores could be demonstrated. Conclusion: The clinical scores (APACHE II, SOFA and REMS) were similar and effective tools for determination of the severity of acute Alp poisoning. However, REMS proved to be more applicable than other scores owing to its simplicity, less time-consuming and effectiveness in emergency situations. Therefore, REMS score is suggested to be used in the emergency situations to predict outcome in Alp poisoned patients.

Comparison of national early warning score, rapid emergency medicine score and acute physiology and chronic health evaluation II score for predicting outcome among emergency severe patients

To analyze the comparation of national early warning score (NEWS), rapid emergency medicine score (REMS) and acute physiology and chronic health evaluation II (APACHE II) score in predicting prognosis of critically ill patients in emergency department (ED). A retrospective study was conducted. Critically ill patients, aged > 16 years, hospitalized > 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE II score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve (ROC). A total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE II in the death group were significantly higher than those in the survival group (NEWS score: 9.40±3.19 vs. 5.72±2.35, REMS score: 12.64±4.46 vs. 7.97±3.28, APACHE II score: 26.64±6.92 vs. 16.19±5.48, all P < 0.01). With the increase of NEWS, REMS and APACHE II score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS < 5, 5-6, ≥ 7 was 3.03% (1/34), 13.33% (4/34), 64.25% (20/51); 28-day mortality of REMS < 12, 12-16, ≥ 17 was 10.99% (10/91), 50.00% (11/22), 66.67% (4/6); 28-day mortality of APACHE II < 15, 15-24, ≥ 25 was 2.33% (1/43), 15.09% (8/59), 69.57% (16/23), respectively, all P < 0.01]. The ROC curve analysis showed that the areas under the ROC curve (AUC) of NEWS, REMS and APACHE II score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval (95%CI) = 0.737-0.923], 0.782 (95%CI = 0.671-0.892) and 0.878 (95%CI = 0.800-0.956), respectively (all P = 0.000), and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively. The scores of NEWS, REMS and APACHE II were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE II forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.

Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: A retrospective cohort study.

Early estimation of mortality risk in patients with trauma is essential. In this study, we evaluate the validity of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) for predicting in-hospital mortality in patients with trauma. Furthermore, we compared the REMS and the EMTRAS with 2 other scoring systems: the Revised Trauma Score (RTS) and Injury Severity score (ISS).We performed a retrospective chart review of 6905 patients with trauma reported between July 2011 and June 2016 at a large national university hospital in South Korea. We analyzed the associations between patient characteristics, treatment course, and injury severity scoring systems (ISS, RTS, EMTRAS, and REMS) with in-hospital mortality. Discriminating power was compared between scoring systems using the areas under the curve (AUC) of receiver operating characteristic (ROC) curves.The overall in-hospital mortality rate was 3.1%. Higher EMTRAS and REMS scores were associated with hospital mortality (P < .001). The ROC curve demonstrated adequate discrimination (AUC = 0.957 for EMTRAS and 0.9 for REMS). After performing AUC analysis followed by Bonferroni correction for multiple comparisons, EMTRAS was significantly superior to REMS and ISS in predicting in-hospital mortality (P < .001), but not significantly different from the RTS (P = .057). The other scoring systems were not significantly different from each other.The EMTRAS and the REMS are simple, accurate predictors of in-hospital mortality in patients with trauma.

Role of severe fever with thrombocytopenia syndrome (SFTS) critical score in predicting the prognosis for SFTS patients

Objective To investigate of the risk factors for the death of severe fever with thrombocytopenia syndrome (SFTS), so as to set up SFTS critical score and evaluate its role in predicting the prognosis for patients with SFTS. Methods A total of 123 SFTS patients hospitalized in Ji′nan Hospital of Infectious Diseases affiliated to Shandong University from June 2011 to October 2014 were enrolled in this study. The univariate Logistic regression analysis was performed to analysis the risk factor for the death of SFTS. Then the SFTS critical score system was set up accordingly. The prognosis value of SFTS critical score was compared with the rapid emergency medicine score (REMS) and the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) by using receiver operator characteristic curve (ROC). Results Among all the patients, 17 males and 14 females were in death group, and 45 males and 47 females were in survival group. The results of the univariate Logistic regression analyses indicated that the glasgow coma scale (GCS), lactate dehydrogenase, activated partial thromboplastin time, oxygen saturation were risk factors for the death of SFTS, with statistically significant difference (all P<0.05). All of the four parameters of SFTS critical scores in the death group were higher than those in the survival group, with statistically significant difference (all P<0.05). The REMS, APACHEⅡ score and SFTS critical score in the death group were significantly higher than those in the survival group (all P<0.01). The area under the curve (AUC) of REMS, APACHEⅡ scores and SFTS critical score were 0.734, 0.746 and 0.788, respectively. The Youden index of the SFTS critical scores was the highest among all three scores (P<0.01). If 15.0 was used as the cut off value of SFTS critical score, the specificity and the sensitivity for predicting the death risk for the hospitalized patient were 74.2% and 76.1%, respectively. Conclusion SFTS critical score, REMS and APACHEⅡ score can all effectively predict the prognosis for SFTS patients, among which, the SFTS critical score is the most convenient and has the best predictive value. Key words: Severe fever with thrombocytopenia syndrome; Critical score; REMS; APACHE; Receiver operating characteristic curve; Logistic models

Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study

ObjectiveRapid Emergency Medicine Score (REMS) is an attenuated version of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and has utility in predicting mortality in non-surgical patients, but...

Perfil de riesgo de pacientes adultos sometidos a traslado secundario por móviles avanzados del sistema de atención médica de urgencia del Área Metropolitana

Secondary transfers of critical patients between hospitals may be associated with risk of death and complicationsTo determine the risk profile of adults subjected to secondary transfers using the Emergency Medical Attention System (SAMU) operating in Metropolitan Santiago.Cross sectional study including 432 adults undergoing secondary transfers using SAMU between January 1 and June 30 2010. Demographic, biomedical, hemodynamic and transfer data were obtained. Cardiopulmonary arrests (CPR) and an increase in the Rapid Emergency Medicine Score (REMS) scale, were considered as outcome variables.CPR occurred in 6.4% of the study population and was significantly associated with the initial REMS score and the need for hemodynamic and ventilator support. The initial REMS score was a good predictor of the final REMS score. The final REMS was significantly associated with the presence of comorbidities and the need for hemodynamic and ventilator support.REMS is a useful scale to assess the risk profile of critical patients requiring transfers between hospitals.

Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock

Background:New scoring systems, including the Rapid Emergency Medicine Score (REMS), the Mortality in Emergency Department Sepsis (MEDS) score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65) score, have been developed for emergency department (ED) use in various patient populations. Increasing use of early goal directed therapy (EGDT) for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined.Objectives:To evaluate the ability of the REMS, MEDS score, and CURB-65 score to predict mortality in septic patients treated with modified EGDT.Materials and Methods:Secondary analysis of data from prospectively identified patients treated with modified EGDT in a large tertiary care suburban community hospital with over 85,000 ED visits annually and 700 inpatient beds, from May 2007 through May 2008. We included all patients with severe sepsis or septic shock, who were treated with our modified EGDT protocol. Our major outcome was in-hospital mortality. The performance of the scores was compared by area under the ROC curves (AUCs).Results:A total of 216 patients with severe sepsis or septic shock were treated with modified EGDT during the study period. Overall mortality was 32.9%. Calculated AUCs were 0.74 [95% confidence interval (CI): 0.67–0.81] for the MEDS score, 0.62 (95% CI: 0.54–0.69) for the REMS, and 0.59 (95% CI: 0.51–0.67) for the CURB-65 score.Conclusion:We found that all three ED-based systems for scoring severity of illness had low to moderate predictive capability. The MEDS score demonstrated the largest AUC of the studied scoring systems for the outcome of mortality, although the CIs on point estimates of the AUC of the REMS and CURB-65 scores all overlap.

Transporte interhospitalario de largo recorrido. Utilidad de las escalas de gravedad

To evaluate the hospital mortality risk for patients transported from a regional hospital to its second-level reference hospital using several scoring systems: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), SAPS II and APACHE II. Prospective observational study of patients transferred from the Sant Hospital in la Seu d'Urgell to the University Hospital Arnau de Vilanova in Lleida, at a distance of 132 km. Consecutive cohort of 134 patients transferred between October 2005 and July 2007. Several data were collected, such as variables on demography, stay, severity score, diagnosis on admission, destination service and procedures, such as mechanical ventilation, inotropics, sedation, neuromuscular blockers and antiarrhythmics. Variable of result was hospital mortality. The average transfer time was 105 +/- 14 minutes; 31.6% of the patients were admitted to an ICU; 16 (11,9%) patients died during hospital stay. The APACHE II and SAPS II scores got significantly higher values in those patients who died. The RAPS and REMS scores showed no significant differences among dead and survivors. The higher the APACHE II and SAPS II scores, the higher the proportion of mortality. The RAPS and REMS scores did not prove to have that tendency. Area under ROC curve was higher for APACHE II (0.76; 95% CI, 0.63-0.89) and SAPS II (0.78; 95% CI, 0.67-0.89), compared to those of RAPS (0.59; 95% CI, 0.43-0.75) and REMS (0.63; 95% CI, 0.49-0.78). The severity of illness measured with APACHE II and SAPS II is able to identify those patients with a higher predictive of mortality. It is a priority to have the right previous stabilization and the adequately trained team to provide care during the transfer, when facing lengthy journey times.