Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department

Abstract

This study aimed to evaluate the performance of the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), and the modified early warning score (MEWS) in predicting the outcomes of adult patients presenting to the emergency department (ED). A retrospective review was undertaken between February 2014 and February 2018 in an adult ED of a 3300-bed university hospital. The RAPS, REMS, and MEWS were calculated to assess their capability to predict hospital admission, length of hospital stay, and in-hospital mortality, using area under receiver operating characteristic analysis. Multivariate analysis was used to identify variables that were independent predictors of the outcomes. We included 39,977 patients who had presented to the ED during 48 consecutive months, of whom 4857 were admitted and 213 died in hospital. The predictabilities of REMS, RAPS, and MEWS for hospital admission were 0.76, 0.59, and 0.55, respectively; the predictability of REMS, RAPS, and MEWS for hospital mortality were 0.88, 0.72, and 0.73, respectively; and the predictability of REMS, RAPS, and MEWS for length of hospital stay were 0.76, 0.67, and 0.65, respectively. Multivariate analysis showed that the Glasgow coma scale (GCS) (odds ratio (OR), 1.61; P < .001), age (OR, 1.50; P < .001), and MAP (OR, 1.27; P < .001) were independent predictors for hospital admission; GCS (OR, 2.92; P < .001), respiratory rate (RR) (OR, 2.69; P < .001), peripheral oxygen saturation (OR, 2.67; P < .001), MAP (OR, 2.11; P < .001), age (OR, 1.75; P < .001), and pulse rate (PR) (OR, 1.73; P < .001) were independent predictors for in-hospital mortality; and RR (OR, 1.41; P < .001), temperature (OR, 1.05; P = .01), and PR (OR, 0.96; P = .04) were independent predictors for length of hospital stay. Our study evaluated and confirmed the REMS as a powerful predictor of ED adult patient outcomes, including hospital admission, length of hospital stay, and in-hospital mortality compared to RAPS and MEWS.

Initial Prehospital Rapid Emergency Medicine Score (REMS) as a Predictor of Patient Outcomes

“…The predictive ability of initial prehospital REMS was greater for mortality than for ED disposition. This finding is consistent with previous work involving REMS calculated in the ED that found an AUROC of 0.76 for hospital admission and 0.88 for mortality (20). Other warning scores, including MEWS and NEWS, have demonstrated similar patterns of stronger prediction for mortality and moderate predictive ability for ED disposition (14).…”

“…The Rapid Acute Physiology Score (RAPS) was adapted from APACHE-II to include only four variables easily obtained in the prehospital or emergency department (ED) settingrespiratory rate, heart rate, blood pressure, and Glasgow Coma Scale (GCS) score (19). The Rapid Emergency Medicine Score (REMS), an extension of RAPS adding peripheral oxygen saturation and patient age, has demonstrated greater predictive ability compared to RAPS in terms of hospital admission and mortality (20).…”

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

“…Given the simplicity and speed required for tools to be effect in triaging multiple trauma patients in EDs, tools such as the modified early warning score (MEWS) (Bozkurt et al, 2015) have now been widely applied in EDs, particularly in China (Xie et al, 2018). The MEWS has been used for many purposes: to predict in-hospital mortality (Xie et al, 2018), determine hospital admission (Wei et al, 2019), identify critically ill patients (Kruisselbrink et al, 2016), and predict injury severity and need for ICU admission (Salottolo et al, 2017).…”

Duel of Emergency Scoring Systems in COVID‐19 Patients

“…REMS has come to the fore among the scoring performed to evaluate critical patients to recognize the patients at high risk in the ED quickly and to prevent mortality. 2 In the study of Hu et al, evaluations regarding Rapid Emergency Medicine Score (REMS) and Modified Early Warning Score (MEWS) were made, and it was stated that REMS diagnostic success was higher. However, as seen in the results, the mean age in the nonsurvivor group was 75.05 AE 12.94, while it was 57.71 AE 15.34 in the survivor group.…”

“…We have read with interest the recent article, “Comparing Rapid Scoring Systems in Mortality Prediction of Critically Ill Patients With Novel Coronavirus Disease” by Hu et al 1 Although there are many studies about the critical patients in the hospital with the diagnosis of COVID‐19, we think that this scoring evaluation is very important especially at the bedside since there are no studies evaluating the scores in the emergency department (ED). REMS has come to the fore among the scoring performed to evaluate critical patients to recognize the patients at high risk in the ED quickly and to prevent mortality 2 …”