Rapid Emergency Medicine Score Research Articles

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.

Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit: A validation study of six existing scores

Introduction“Early warning scores” (EWS) have been developed to quantify levels of vital sign abnormality. However, many scores have not been validated. The aim of this study was to validate six scores that all rely on vital signs: Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS) and the National Early Warning Score (NEWS) and the Goodacre, Groarke and Worthing physiological scores. MethodsA posthoc single-center observational cohort study of prospectively collected vital signs on acutely admitted medical patients to a Danish hospital. All adult patients arriving at an acute medical unit at a 450-bed regional teaching hospital were included. Upon arrival, we registered initial vital signs and only the first presentation in the study period was included. Patients were included from 1 June to 31 October 2012. All-cause 24-h mortality and overall in-hospital mortality were used as endpoints. A discriminatory power above 0.8 was considered acceptable. Results5784 patients were included with a median age of 67 (49–78) years, 32 (0.6%) died within 24h and 161 (2.8%) while admitted. Discriminatory power for 24h mortality was above 0.8 for all scores (except the Groarke score (0.587)) and highest for the Worthing score (0.847). The discriminatory power for predicting overall in-hospital mortality was highest for the Goodacre and Worthing scores (0.810 and 0.800 respectively) but below 0.8 for the remaining scores. ConclusionThe Goodacre score and the Worthing physiological score have good discriminatory power at identifying patients at increased risk of 24-h and in-hospital mortality in our setting.

Performance of physiology scoring systems in prediction of in-hospital mortality of traumatic children: A prospective observational study

BackgroundThis study is designed to compare the value of four physiologic scoring systems of rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), Worthing physiology scoring system (WPSS) and revised trauma score (RTS) in predicting the in-hospital mortality of traumatic children brought to the emergency department. MethodWe used the data gathered from six healthcare centers across Iran between the April-October 2016. Included patients were all children with trauma. Patients were assessed and followed until discharge. Moreover, patients were divided to two groups of died and alive, and discriminatory power and general calibration of models in prediction of in-hospital mortality were compared. ResultsData was gathered from 814 children (average age of 11.65±5.36years, 74.32% boys). Highest measured area under the curve was for RAPS and REMS with 0.986 and 0.986, respectively. Areas under the curve of WPSS and RTS were 0.920 and 0.949, respectively (p=0.02). Sensitivity and specificity of RAPS were 100.0 and 95.05, respectively. These amounts for REMS were 100.0 and 94.04, respectively. Two models of RTS and WPSS had the same sensitivity of 84.62. Specificity of these two was 98.22 and 96.95, respectively. Three models of RAPS, REMS and RTS had proper calibrations in predicting mortality; however, it seems that WPSS overestimates the mortality in high risk patients. ConclusionAs calculations of RAPS is easier than REMS and their proper calibrations, it seems that RAPS is the best physiologic model in predicting in-hospital mortality and classifying in traumatic children based on severity of injury. However, further validation of the recommended score is essential before implementing them into routine clinical practice.

The modified rapid emergency medicine score: A novel trauma triage tool to predict in-hospital mortality

BackgroundTrauma 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. MethodsThe 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. ResultsOverall 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. ConclusionIn 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.

Rapid Acute Physiology Score versus Rapid Emergency Medicine Score in Trauma Outcome Prediction; a Comparative Study.

Rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) are two physiologic models for measuring injury severity in emergency settings. The present study was designed to compare the two models in outcome prediction of trauma patients presenting to emergency department (ED). In this prospective cross-sectional study, the two models of RAPS and REMS were compared regarding prediction of mortality and poor outcome (severe disability based on Glasgow outcome scale) of trauma patients presenting to the EDs of 5 educational hospitals in Iran (Tehran, Tabriz, Urmia, Jahrom and Ilam) from May to October 2016. The discriminatory power and calibration of the models were calculated and compared using STATA 11. 2148 patients with the mean age of 39.50±17.27 years were studied (75.56% males). The area under the curve of REMS and RAPS in predicting in-hospital mortality were calculated to be 0.93 (95% CI: 0.92-0.95) and 0.899 (95% CI: 0.86-0.93), respectively (p=0.02). These measures were 0.92 (95% CI: 0.90-0.94) and 0.86 (95% CI: 0.83-0.90), respectively, regarding poor outcome (p=0.001). The optimum cut-off point in predicting outcome was found to be 3 for REMS model and 2 for RAPS model. The sensitivity and specificity of REMS and RAPS in the mentioned cut offs were 95.93 vs. 85.37 and 77.63 vs. 83.51, respectively, in predicting mortality. Calibration and overall performance of the two models were acceptable. The present study showed that adding age and level of arterial oxygen saturation to the variables included in RAPS model can increase its predictive value. Therefore, it seems that REMS could be used for predicting mortality and poor outcome of trauma patients in emergency settings.

Performance of Early-Warning Scores in Predicting Mortality in an HIV-Infected Population with Sepsis in Uganda

Background Early-warning scores (EWS) have the potential to improve resource allocation and hasten care in sub-Saharan Africa (SSA). Despite the high prevalence of HIV infection in SSA, current EWS do not take into account HIV serostatus.Methods We conducted a retrospective study at Mbarara Regional Referral Hospital (MRRH) in Uganda to evaluate the performance of CRB-65, modified early-warning score (MEWS), quick sepsis-related organ failure assessment (qSOFA), rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), South African triage scale (SATS), and shock index (SI) in predicting mortality among HIV-infected patients presenting with sepsis. We included patients admitted with sepsis to MRRH between January 2014 and December 2015 that had an HIV-positive serostatus and at least one valid heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, temperature, and oxygen saturation. Glasgow coma scale was imputed with the median. We used the area under the receiver operating curve (AUC) with tenfold cross-validation to assess the performance of each EWS.ResultsOf the 193 patients, the median (interquartile range) age was 34 (27, 42) years, 87 (45.0%) were female and 65 (44.6%) died. The AUC (95% confidence interval) was 0.53 (0.43, 0.62) for CRB65, 0.53 (0.44, 0.62) for MEWS, 0.57 (0.46, 0.68), for qSOFA, 0.60 (0.51, 0.69) for RAPS, 0.55 (0.46, 0.63) for REMS, 0.53 (0.45, 0.62) for SATS, and 0.54 (0.46, 0.63) for SI.Conclusion The ability of EWS to predict mortality in an HIV-infected patient population with sepsis in Uganda was poor. EWS used in SSA should be derived from African patient populations and adjust for HIV serostatus.Disclosures All authors: No reported disclosures.

Evaluating clinical care in the prehospital setting: Is Rapid Emergency Medicine Score the missing metric of EMS?

IntroductionThe Rapid Emergency Medicine Score (REMS) was developed to predict emergency department patient mortality. Our objective was to utilize REMS to assess initial patient acuity and evaluate clinical change during prehospital care. MethodsAll non-cardiac arrest emergency transports from April 1, 2013 to March 31, 2014 were analyzed from a single EMS agency. Using age, pulse rate, mean arterial pressure, respiratory rate, oxygen saturation, and Glasgow Coma Scale, initial and final REMS were calculated. Change in REMS was calculated by initial minus final with a positive number indicating clinical improvement. Descriptive analyses were performed calculating means and 95% confidence intervals. ResultsThere were 61,346 patients analyzed with an average initial REMS of 4.3 (95% CI: 4.2–4.3) and an average REMS change of 0.37 (95% CI: 0.36–0.38). Those patients classified with the highest dispatch priority had the highest initial REMS (5.8; 95% CI: 5.5–6.2) and the greatest change (0.95; 95% CI: 0.72–1.17). Patients transported with high priority had greater initial REMS, as well as greater improvement in REMS (high priority 7.3 [95% CI: 7.1–7.4], change 0.61 [95% CI: 0.53–0.69]; middle priority 5.3 [95% CI: 5.2–5.4], change 0.55 [95% CI: 0.51–0.59]; low priority 3.9 [95% CI: 3.8–3.9], change 0.32 [95% CI: 0.31–0.33]). ConclusionDescriptive analyses indicate that as dispatch and transport priorities increased in severity so too did initial REMS. The largest change in REMS was seen in patients with the highest dispatch and transport priorities. This indicates that REMS may provide system level insight into evaluating clinical changes during care.

11 The Modified Rapid Emergency Medicine Score: A Novel Trauma Triaging Tool for Predicting In-hospital Mortality

11 The Modified Rapid Emergency Medicine Score: A Novel Trauma Triaging Tool for Predicting In-hospital Mortality

Comparison of different scores as predictors of mechanical ventilation in drug overdose patients.

The decision of intubation and mechanical ventilation in poisoned patients with impaired consciousness can be a difficult task. The present study aimed to evaluate the power of Glasgow Coma Scale (GCS), acute physiology and chronic health evaluation (APACHE II), rapid acute physiology score (RAPS) and rapid emergency medicine score (REMS) at admission in predicting the need of intubation and mechanical ventilation in drug overdose patients with disturbed consciousness level (DCL). This prospective observational study was conducted on 104 poisoned patients who were admitted to Tanta Toxicological Unit with a DCL. Four scoring systems (GCS, APACHE II, RAPS and REMS) were recorded for all patients on admission. Discrimination was evaluated using receiver operating characteristics curve and calculating the area under the curve (AUC). Twenty-four cases required mechanical ventilation. The mechanically ventilated patients had significantly lower value of GCS and higher values of APACHE II, REMS and RAPS than other group ( p < 0.001). Although the APACHE II score has the best AUC value (0.796) in predicting mechanical ventilation, there was no statistically significant difference between the four scores. GCS > 8 had 100% negative predictive value, while REMS > 8 had 100% positive predictive value.

Predictive accuracy and feasibility of risk stratification scores for 28-day mortality of patients with sepsis in an emergency department.

Sepsis is associated with high mortality. Because early therapy has proven to decrease mortality, a risk stratification tool that quickly and easily quantifies mortality risk of patients will be helpful to guide appropriate treatment. We investigated five scores in terms of (a) predicting 28-day mortality and (b) their feasibility for use in the emergency department (ED). We carried out a historical cohort study in the ED of Maastricht University Medical Centre (MUMC). Patients who fulfilled the criteria for sepsis were included if they had been admitted to the hospital by an internist between August 2009 and August 2010. The Mortality in Emergency Department Sepsis (MEDS), Confusion, Urea, Respiratory rate, Blood pressure, age>65 (CURB-65), Acute Physiology And Chronic Health Evaluation II (APACHE II), Rapid Acute Physiology Score (RAPS), and Rapid Emergency Medicine Score (REMS) scores were calculated using ED charts. The primary outcome was total 28-day mortality. Receiver operating characteristic curves and calibration plots were constructed to evaluate predictive accuracy. Feasibility was defined as the proportion of patients for whom all data were available. We included 600 patients, of whom 90 (15%) died within 28 days. Discriminating ability for total 28-day mortality of the MEDS [area under the curve (AUC): 0.82, 95% confidence interval (CI) 0.78-0.87], CURB-65 (AUC: 0.78, 95% CI 0.73-0.83), and APACHE II (AUC: 0.71, 95% CI 0.64-0.79) was the highest, but only the difference between the MEDS and REMS (P=0.007) and the RAPS score (P<0.001) was significant. Both the MEDS and the CURB-65 had higher AUCs for predicting 28-day in-hospital mortality than the other three scores, but this was only significant for the MEDS score compared with the RAPS (P=0.003). Both the MEDS and the CURB-65 underestimated mortality, especially for the higher scores. The MEDS, CURB-65, REMS, and RAPS were most feasible as they could be calculated in more than 96% of patients. The MEDS and CURB-65 scores are the most adequate and feasible tools for the prediction of total 28-day mortality in septic patients presenting at the ED, but they need local recalibration before use in the ED.

Prognostic performance of the Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) in emergency department.

BackgroundThe Rapid Emergency Medicine Score (REMS) and Worthing Physiological Scoring system (WPS) have been developed for predicting in-hospital mortality in nonsurgical emergency department (ED) patients. The prognostic performance of the scoring systems in independent populations has not been clear. The aim of the study is to evaluate the prognostic accuracy of REMS and WPS systems in the estimation of 30-day mortality risk among medical patients in ED.MethodsThe study was designed as a prospective investigation, with the setting being the ED of the National Hospital of Can Tho, Vietnam. We enrolled medical patients aged 16+ years who met the study entry criteria. Clinical data were obtained as required for each scoring system. The primary outcome was mortality within 30 days since hospitalization. The association between each scoring system and mortality was assessed by the hazard ratio (HR) of the Cox’s proportional hazard model.ResultsThe study involved 1746 patients, average age 65.9 years (SD 17). During the period of follow-up, 172 patients (9.9 %) died. The risk of 30-day mortality was increased by 30 % for each additional REMS unit (HR: 1.28; 95 % confidence interval (CI): 1.23–1.34) and by 60 % for each additional WPS unit (HR: 1.6; 95 % CI: 1.5–1.7). The AUC of the REMS was 0.71 (95 % CI: 0.67–0.76) which was significantly lower than that of the WPS (0.80; 95 % CI: 0.76–0.83).ConclusionsBoth REMS and WPS have good prognostic value in the prediction of death in ED patients. The WPS appeared to have a better prognostic performance than the REMS system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0066-3) contains supplementary material, which is available to authorized users.

Rapid Emergency Medicine Score and HOTEL Score in Geriatric Patients Admitted to the Emergency Department

Emergency risk scoring systems have been defined in order to identify the health status of the patients on admission to the emergency department. In this study, we aimed to investigate the prognostic values of Rapid Emergency Medicine Score (REMS), REMS without age and the HOTEL scores in geriatric patients. This prospective, single-centered, observational study was carried out between the January 15, 2014 February 28, 2014. Patients admitted to the emergency department during the study period and aged 65 years or older were included in the study. In total, 939 patients were included in the study. In predicting the intensive care unit admission, the area under the curve values of the REMS, REMS without age, and HOTEL scores were 0.772, 0.760, and 0.827 ( p < 0.001, for all), respectively. The median (interquartile range) REMS and REMS without age scores of the nonsurvivors were statistically significantly higher than those of the survivors [10 (6) vs. 6 (3), 5 (6) vs. 1 (2), respectively; p < 0.001 for both]. Similarly, the HOTEL scores of the nonsurvivors were also statistically significantly higher than those of the survivors [2 (1) vs. 1(1), p < 0.001]. In predicting the in-hospital mortality, the area under the curve values of the REMS, REMS without age and HOTEL scores were 0.833, 0.819, and 0.858 ( p < 0.001 for all), respectively. The REMS, REMS without age, and the HOTEL scores cannot be efficiently employed to discriminate geriatric patients requiring hospitalization. Nonetheless, all three scores are proper predictive systems regarding intensive care unit admission and in-hospital mortality in geriatric emergency department patients.

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

Venous lactate in predicting the need for intensive care unit and mortality among nonelderly sepsis patients with stable hemodynamic

ObjectivesOur study aims to investigate the role of initial venous lactate in predicting the probability of clinical deterioration and 30-day mortality in nonelderly sepsis patients with acute infections, without hemodynamic shock. MethodsWe enrolled emergency department patients aged 18 to 65 years with acute major infections, but without organ hypoperfusion, and obtained a single venous lactate measurement at initial presentation. As the primary end point, the eligible patients were tracked for the need for vasopressor or mechanical ventilation (MV) in the next 72 hours. The patients' venous lactate and related risk factors were analyzed. We also followed the cohort and the predictors to investigate their prognostic role for 30-day mortality. ResultsOf 392 patients, 74 required vasopressor/MV, and 388 patients were available for mortality analysis. An initial lactate greater than or equal to 2 mmol/L was the strongest independent predictor for the requirement of vasopressor/MV (adjusted odds ratio, 6.2; 95% confidence interval, 3.4-11.3). The other independent risk factors were immunosuppressive drug users and positive blood culture. However, the initial lactate was not associated with 30-day mortality. The factors that were associated with mortality were the use of vasopressor/MV, active malignancy, Rapid Emergency Medicine Score greater than or equal to 6, and hospitalization within 90 days. ConclusionsIn nonelderly sepsis patients with stable hemodynamic, elevated venous lactate (≥2 mmol/L) was associated with an increased probability of the need for vasopressor/MV. However, unfavorable medical histories and the severity of physiologic changes may be associated with short-term mortality to a greater extent than the single value of initial lactate.

Intensive care unit scoring systems outperform emergency department scoring systems for mortality prediction in critically ill patients: a prospective cohort study.

BackgroundMultiple scoring systems have been developed for both the intensive care unit (ICU) and the emergency department (ED) to risk stratify patients and predict mortality. However, it remains unclear whether the additional data needed to compute ICU scores improves mortality prediction for critically ill patients compared to the simpler ED scores.MethodsWe studied a prospective observational cohort of 227 critically ill patients admitted to the ICU directly from the ED at an academic, tertiary care medical center. We compared Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Score (SAPS) II, Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), Prince of Wales Emergency Department Score (PEDS), and a pre-hospital critical illness prediction score developed by Seymour et al. (JAMA 2010, 304(7):747–754). The primary endpoint was 60-day mortality. We compared the receiver operating characteristic (ROC) curves of the different scores and their calibration using the Hosmer-Lemeshow goodness-of-fit test and visual assessment.ResultsThe ICU scores outperformed the ED scores with higher area under the curve (AUC) values (p = 0.01). There were no differences in discrimination among the ED-based scoring systems (AUC 0.698 to 0.742; p = 0.45) or among the ICU-based scoring systems (AUC 0.779 to 0.799; p = 0.60). With the exception of the Seymour score, the ED-based scoring systems did not discriminate as well as the best-performing ICU-based scoring system, APACHE III (p = 0.005 to 0.01 for comparison of ED scores to APACHE III). The Seymour score had a superior AUC to other ED scores and, despite a lower AUC than all the ICU scores, was not significantly different than APACHE III (p = 0.09). When data from the first 24 h in the ICU was used to calculate the ED scores, the AUC for the ED scores improved numerically, but this improvement was not statistically significant. All scores had acceptable calibration.ConclusionsIn contrast to prior studies of patients based in the emergency department, ICU scores outperformed ED scores in critically ill patients admitted from the emergency department. This difference in performance seemed to be primarily due to the complexity of the scores rather than the time window from which the data was derived.

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...

Comparison of value of GRACE, APACHEII and REMS for early prognosis of death in patients with acute myocardial infarction

To evaluate and compare the predictive value of short-term risk of death of global registry of acute coronary events (GRACE) risk scores, acute physiology and chronic health evaluation II (APACHEII) scores and rapid emergency medicine score (REMS) in patients with acute myocardial infarction (AMI). A retrospective review of clinical data of 390 patients with AMI admitted from October 2012 to March 2013 in emergency department and cardiology care unit (CCU) in Guizhou People's Hospital were performed. The lowest scores within 24 hours of GRACE risk score, APACHEII risk score, and REMS risk score, respectively, for each patient were recorded. Mortality rate within 30 days after onset was calculated. Prediction of the mortality rate of AMI within 30 days as made in three scoring systems was compared. A total of 54 patients died from cardiovascular disease within 30 days. GRACE risk scores, APACHEII scores, and REMS risk scores were higher in non-survivors as compared with that of survivors (GRACE: 206.09±24.67 vs. 150.17±25.72, t=-4.349, P=0.000; APACHEII: 15.81±7.60 vs. 7.50±2.83, t=-4.182, P=0.000; REMS: 7.11±2.70 vs. 5.38±2.59, t=-2.345, P=0.020). Area under the receiver operator characteristic curve (ROC curve) for GRACE risk scores, APACHEII risk scores and REMS in patients with AMI died from cardiac vascular disease in 30 days were 0.862 [95% confidence interval (95%CI) 0.76-0.95, P=0.000], 0.825 (95%CI 0.71-0.93, P=0.002) and 0.615 (95%CI 0.46-0.77, P=0.192), sensitivity of three kinds of scoring system was 92.32%, 76.91%, 69.26%, respectively, with specificity of 66.23%, 77.84%, 54.02% respectively. GRACE and APACHEII scores for patients with AMI risk of short-term death showed more accurate in predicting early than GRACE scores, and REMS for AMI risk of short-term death did not have predictive value.

Validating Severity of Illness Scoring Systems in the Prediction of Outcomes in Staphylococcus aureus Bacteremia

BackgroundSeverity of illness scores are helpful in predicting mortality; however, no standardized scoring system has been validated in patients with Staphylococcus aureus bacteremia (SAB). The modified Rapid Emergency Medicine Score (REMS), the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 65) and the Charlson weighted index of comorbidity (CWIC) were compared in predicting outcomes at the onset of SAB. MethodsAll adult inpatients with SAB from July 15, 2008, to December 31, 2009, were prospectively assessed. The 3 scoring systems were applied: REMS, CURB-65 and CWIC. The end points were attributable and overall mortality. ResultsA total of 241 patients with SAB were reviewed during the study period. The all-cause mortality rate was 22.8% and attributable mortality 14.1%. Patients who died had higher mean CURB-65 score and REMS than those who lived, whereas the difference in the CWIC score was not significant. Two logistic regression models based on CURB-65 score or REMS, after controlling for CWIC, revealed that both scores were independent predictors of mortality, with an odds ratio of 3.38 (P<0.0001) and 1.45 (P<0.0001) for CURB-65 and REMS, respectively. Receiver operating characteristic analysis revealed that a cutoff point of 3.0 (CURB-65) and 6.0 (REMS) provided the highest sensitivity and specificity. The area under the curves for all-cause mortality were 0.832 and 0.806, and for attributable mortality 0.845 and 0.819, for CURB-65 and REMS, respectively. ConclusionsREMS and CURB-65 scores outperformed CWIC as predictors of mortality in SAB and may be effective in predicting the severity of illness at the onset of bacteremia.

Rapid Emergency Medicine Score as a main predictor of mortality in Vibrio vulnificus–related patients

ObjectivesVibrio vulnificus causes potentially life-threatening and rapidly progressing infections. Therefore, the severity-of-illness assessment appears to be important for V vulnificus–infected patients at the time of admission. The aim of our study was to evaluate the performance of the severity-of-illness scoring model on admission in V vulnificus–infected patients. MethodsOne hundred seventy-one consecutive patients (mean age: 63.1 ± 12.3 years) with V vulnificus infection who were admitted to a teaching hospital between January 1999 and June 2010 were included in the study. Demographic and clinical characteristics, illness severity on admission, treatment, and outcomes were collected for each patient and extracted for analysis. Logistic regression and receiver operating characteristic curve analyses were performed. ResultsThe mean Rapid Emergency Medicine Score (REMS) on admission was 6.5 ± 3.0 points. During hospitalization, 68 patients (40%) required intensive care. The overall case-fatality rate was 25%. In multivariate analysis, the presence of underlying liver disease (P = .002), hemorrhagic bullous lesions/necrotizing fasciitis (P = .012), and higher REMS values on admission (P < .0001) were associated with increased mortality risk; a time span <24 hours between arrival and surgical treatment was associated with a decreased mortality risk (P = .007). Additionally, the area under the receiver operating characteristic (ROC) curve for the REMS in predicting mortality risk was 0.895 (P < .0001). An optimal cut-off REMS ≥8 had a sensitivity of 81% and a specificity of 85%, with a 26.6-fold mortality risk (P < .0001) and a 12.5-fold intensive care unit admission risk (P < .0001). ConclusionThe REMS could provide clinicians with an effective adjunct risk stratification tool for V vulnificus–infected patients.

The comparison of modified early warning score with rapid emergency medicine score: a prospective multicentre observational cohort study on medical and surgical patients presenting to emergency department

ObjectiveThere are a few scoring systems in emergency departments (ED) to establish critically ill patients quickly and properly and to predict hospitalisation. We aim to compare the efficacy of Modified...