Assessment of The Relationship of REMS and MEWS Scores with Prognosis in Patients Diagnosed with Covid-19 Admitted to the Emergency Department

Abstract

AimWith the rapid and global increase in COVID-19 cases, it is becoming important to identify patients with a risk of mortality and patients that need hospitalization. The aim of this study is to try to predict the mortality rate of COVID patients admitted to the emergency department with rapid scoring systems such as REMS and MEWS and their clinical termination in the emergency department at the end of the first month.MethodWe have designed this study to be a single-centered, prospective and an observational study. A total of 392 patients diagnosed with COVID-19, who were admitted to the emergency department in a 1-month period, were included in the study. REMS and MEWS scores were calculated for each case. Demographic data of patients, clinical outcomes such as discharge, service hospitalization, ICU hospitalization, and first-month mortality were analysed based on these scores. ROC curves were analysed to determine the cut-off value with the help of which REMS and MEWS scores can predict 1-month mortality and hospitalization.ResultsOut of the 392 patients included in the study, the 43.4% (n=170) were female and 56.6% (n=222) were male. The average age of our patients was 48.98±19.49 years. The 1-month mortality rate of our patients was 4.3% (n=17). At the end of the first month, the mortality of patients with a comorbid disease was higher than those who did not (p<0.01). The average of the REMS score was higher in patients with an average mortality of (7.24±3.77) than in patients without it (2.87±3.09), and there was a statistically significant difference between them (p<0.01). Similarly, the average of the MEWS score was higher in patients with an average mortality of (2.76±1.86) than in patients without it (1.65±1.35), and there was a statistically significant difference (p<0.01). The REMS score of patients admitted to the service was higher than that of patients discharged (p<0.01). When the REMS score was determined as 3 cut-off value in ROC analysis, service hospitalization was 5 times higher in patients with a REMS score of 3 and above than in those who were discharged (OR: 1:5.022 95% CI: 3.088-8.168)). REMS and MEWS scores were also higher in ICU patients than in discharged patients (p<0.01).ConclusionIn predicting the 1-month mortality of ER patients diagnosed with COVID-19, REMS and MEWS scoring systems can be useful and guiding in determining the patients who need hospitalization for emergency physicians. The use of these scoring systems in emergency departments can help predict the clinical outcomes of patients at the time of the initial evaluation, and can also be a practical method of predicting the prognosis of the patients.

Prognostic Value of Physiological Scoring Systems in COVID-19 Patients

“…In another study, the REMS and MEWS scores were compared. The results confirmed that the REMS (AUC = 0.818, cutoff value of 5 and greater) and MEWS (AUC = 0.681, cutoff value of 3 and greater) scoring systems helped predicting the 1-month mortality of COVID-19 patients (Bas et al, 2022). A retrospective study with 13,830 COVID-19 patients confirmed that the REMS score was a robust tool for predicting ED mortality, hospital mortality, and ED discharge (Bourn et al, 2021).…”

“…Studies have shown that there is a significant relationship among predisposing factors such as age, gender, and comorbidities, and the clinical course of COVID-19 patients (Bajema et al, 2020; Chan et al, 2020; Chen et al, 2020; Sakurai et al, 2020). These factors are the principal variables for the calculation of physiological scoring systems (Bas, Senturk, Burnaz, Timur, & Kalkan, 2022; Covino et al, 2020).…”

Evaluation of mortality in ICU-hospitalized COVID-19 patients by using REMS, APACHE-II, CCI, and SOFA

“…[20] A study including 392 COVID-19 patients admitted to the ED was examined and it was reported that REMS could be guiding for physicians to estimate the one-month mortality of ED patients with COVID-19. [21] In another study, Hai Hu et al…”

Prognostic accuracy of early warning scores for predicting serious illness and in-hospital mortality in patients with COVID-19

“…In predicting serious illness development, REMS took second place. The study performed on 392 patients admitted to the emergency department in a hospital in Turkey displayed REMS as a useful scoring system in predicting 1-month mortality and clinical outcome [ 42 ]. A study from the USA on trauma population and another study in the UK in the emergency department showed REMS performed better as a predictor of mortality in emergency medical admissions than other scores [ 31 , 43 ].…”