Predictive Ability of the MEWS, REMS, and RAPS in Geriatric Patients With SARS-CoV-2 Infection in the Emergency Department

Abstract

Background: To compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30 day-mortality in patients with SARS-CoV-2 infection aged 65 years and over. Methods: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 years and over with patients confirmed to have SARS-CoV-2 infection according to the RT-PCR test, who presented to the emergency department between March 1, 2020 and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS and RAPS values of the patients were recorded prospectively. Results: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) years. The rate of 30-day mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS and REMS were 0.512 [95% confidence interval (CI): 0.420-0.604, p = 0.910], 0.500 (95% CI: 0.408-0.592, p = 0.996), and 0.675 (95% CI: 0.585-0.757, p = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2) and REMS (>5) for 30-day mortality were 0.374 (95% CI: 0.089-1.568, p = 0.179), 1.696 (95% CI: 0.090-31.815, p = 0.724), and 1.008 (95% CI: 0.257-3.948, p = 0.991), respectively. Conclusion: REMS, RAPS and MEWS do not seem to be useful in predicting 30-day mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency department.

Prognostic Value of Symptoms and Signs in Geriatric Acute Pulmonary Embolism—An Analytical Study

“…Scoring systems consisting of physical examination findings, vital parameters and laboratory parameters and their combination are used for clinical decision-making and patient management. 9 10 Pulmonary embolism severity index (PESI), simplified PESI and geriatric PESI scores are used for APE. 11 In this study, we hypothesized and tested that clinical symptoms may be associated with short-term mortality in geriatric patients with APE in the emergency department.…”

Evaluation of Early Warning Scores on In-Hospital Mortality in COVID-19 Patients: A Tertiary Hospital Study from Taiwan

“…In contrast, EWS permit immediate risk stratification and can be incorporated into a rapid response system to ensure timely intervention and avoid future adverse events [ 2 ]. Previous studies have demonstrated the importance of EWS in identifying COVID-19 patients at risk of deterioration [ 14 , 15 , 16 , 17 ]; however, a comparison of the three most utilized indices has not been reported.…”

“…However, NEWS does not include age, and we have noticed that geriatric patients are more vulnerable to COVID-19 [ 9 , 22 ]. Thus, REMS, which includes age as a parameter, is better than both NEWS and MEWS [ 14 , 17 ].…”

“…REMS was first reported in 2004 in a prospective cohort study of 12,006 nonsurgical patients admitted from the ED and was demonstrably superior to another EWS—namely, the RAPS. [ 5 ] One study investigated the accuracy of REMS in predicting 30-day mortality in geriatric COVID-19 patients and reported that it is better than both RAPS and MEWS [ 17 ]. Similarly, other reports have also found REMS to be preferable to MEWS in COVID-19 patients aged younger than 65 years [ 14 ].…”

Diagnostic accuracy of clinical gestalt of doctors with different experiences in COVID-19 suspected patients

“…Various clinical scenarios have been studied on the gestalt of clinicians (8). In the COVID-19 pandemic, clinicians had to make vital decisions, given the burden on the healthcare system, especially in the early stages of the disease (9). Many clinicians have had to manage clinical condition of COVID-19 patients they have not encountered before.…”