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

Abstract

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 has yet to be tested among the trauma population. The objective was to evaluate REMS as a risk stratification tool for predicting in-hospital mortality in traumatically injured patients and to compare REMS accuracy in predicting mortality to existing trauma scores, including the Revised Trauma Score (RTS), Injury Severity Score (ISS) and Shock Index (SI).Design and settingRetrospective chart review of the trauma registry from an urban academic American College of Surgeons (ACS) level 1 trauma centre.Participants3680 patients with trauma aged 14 years and older admitted to the hospital over a 4-year period. Patients transferred from other hospitals were excluded from the study as were those who suffered from burn or drowning-related injuries. Patients with vital sign documentation insufficient to calculate an REMS score were also excluded.Primary outcome measuresThe predictive ability of REMS was evaluated using ORs for in-hospital mortality. The discriminate power of REMS, RTS, ISS and SI was compared using the area under the receiver operating characteristic curve.ResultsHigher REMS was associated with increased mortality (p<0.0001). An increase of 1 point in the 26-point REMS scale was associated with an OR of 1.51 for in-hospital death (95% CI 1.45 to 1.58). REMS (area under the curve (AUC) 0.91±0.02) was found to be similar to RTS (AUC 0.89±0.04) and superior to ISS (AUC 0.87±0.01) and SI (AUC 0.55±0.31) in predicting in-hospital mortality.ConclusionsIn the trauma population, REMS appears to be a simple, accurate predictor of in-hospital mortality. While REMS performed similarly to RTS in predicting mortality, it did outperform other traditionally used trauma scoring systems, specifically ISS and SI.

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

“…While REMS has been shown to be an accurate predictor of mortality in the non-surgical non-trauma medicine population [14], the score needed to be adjusted to accurately predict mortality in trauma patients. When evaluated in the trauma population, it was suggested that the GCS was underweighted and that age was over weighted [15]. As SBP is the most widely used and recorded indicator of trauma severity, mREMS was designed to include SBP instead of MAP, which was included in the original REMS score.…”

“…A previous study by our group evaluated the REMS in a trauma population and hypothesized that the weighting of GCS was too low, the weighting of age was too high, and that mechanism of injury might be able to be incorporated into the score, to better represent trauma patients [15]. For the mREMS score the relative weighting of age has been decreased and the weighting of GCS has been increased, to provide a more accurate predictor of mortality in trauma patients.…”

“…The results showed that there could be room for improvement, to optimize the score for trauma patients. It was hypothesized that the variable age was over weighted and that GCS was under weighted [15].…”

Improving Healthcare Team Collaboration in Hospital Transfers through Cloud-Based Mobile Systems

“…In [21], a study conducted amongst traumatically injured patients found a similar correlation between REMS and in-hospital mortality (AUC of 0.91). For our case in particular, REMS has also been proven to perform relatively well when assessing mortality risk in interhospital transfers.…”

Deterioro fisiopatológico y mortalidad, de pacientes críticos adultos sometidos a traslado por móviles del servicio de atención médica de urgencia del área metropolitana, Santiago de Chile

“…Originalmente presento una buena precisión predictiva en la evaluación de pacientes no quirúrgicos 16,17 , sin embargo, los estudios más recientes mostraron su buen desempeño como predictor de mortalidad hospitalaria en victimas de trauma 41,42 y pacientes atendidos en servicios de emergencia por causas clínicas y quirúrgicas 43 Los cambios indeseables en las condiciones fisiológicas son frecuentes durante la transferencia de pacientes críticamente enfermos y pueden amenazar la vida, en especial, de pacientes dependientes de ventilación mecánica y termodinámicamente inestables. En consecuencia, en las publicaciones que analizan los factores de riesgo para eventos adversos durante o transporte destacándose el uso de ventilación mecánica y drogas vasoactivas 44 .…”