The utility of the rapid emergency medicine score (REMS) compared with SIRS, qSOFA and NEWS for Predicting in-hospital Mortality among Patients with suspicion of Sepsis in an emergency department

Abstract

Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED. Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality. Results A total of 1622 patients were included in the study; 457 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p = 0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p < 0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p = 0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality. Conclusion REMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS), similar to NEWS, and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

Performance of Scoring Systems in Predicting Clinical Outcomes in Patients with Bacteremia of Listeria monocytogenes: A 9-Year Hospital-Based Study

“…A number of clinical scoring systems are available to quickly stratify patients and to identify potentially critical conditions in ED and intensive care units based on variable physiological parameters [ 20 , 36 ]. With these simple and easy-to-use clinical scoring systems, physicians can quickly decide on the patient’s treatment options and can start early goal-directed therapy such as appropriate antibiotics treatment.…”

“…NEWS is used in America to determine the risk of mortality for inpatients with and without infections [ 38 ]. In Thailand, REMS has a higher accuracy in predicting the in-hospital mortality, when compared with sepsis-related scores (qSOFA and systemic inflammatory response syndrome) for patients with suspected sepsis in ED [ 36 ].…”

Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study

“…11 The higher the score, the higher the patient's criticality, with the severity of the patient's condition evaluated according to the patient's score. 12 The scoring method, T-RTS, comprises three indicators, namely, systolic blood pressure, breathing rate and the GCS score; the lower the score, the more serious the injury. 13 Similar to the two previous triage methods, TEWS uses a scoring method which, in this method, comprises seven indicators, that is, mobility, breathing rate, heart rate, systolic blood pressure, body temperature, state of consciousness and level of trauma; the higher the score, the more severe the injury.…”

Comparison of the National Early Warning Scores and Rapid Emergency Medicine Scores with the APACHE II Scores as a Prediction of Mortality in Patients with Medical Emergency Team Activation: A Single-centre Retrospective Cohort Study

“…It was developed to distinguish patients at risk of ICU admission and death by including age as a variable. It can also be used in emergency departments [ 10 ]. However, it remains unclarified whether REMS effectively distinguishes patients at risk of deteriorating conditions during hospitalization.…”