The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study

Martin-Rodríguez, Francisco; Sanz-García, Áncor; Medina-Lozano, Elena; Villamor, Miguel Ángel Castro; Rodríguez, Virginia Carbajosa; Vegas, Carlos Del Pozo; Millán, Laura; Rabbione, Guillermo Ortega; Conty, José Luis Martín; López-Izquierdo, Raúl

doi:10.1080/10903127.2020.1813224

Cited by 20 publications

(40 citation statements)

References 36 publications

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“…We limited this analysis to patients diagnosed with COVID‐19 to specifically examine predictive characteristics of REMS in this unique patient population with a novel disease. Prior studies have demonstrated the value of prehospital REMS for predicting hospital outcomes for a general cohort of EMS‐transported patients, suggesting utility even when the EMS suspicion of COVID‐19 may not be confirmed 14,17 . Nevertheless, future research will be required to determine whether REMS is a useful predictor of hospital outcomes for the subset of EMS patients with suspected COVID‐19 with and without confirmation at the hospital after transport.…”

Section: Limitationsmentioning

confidence: 99%

“…This study was also limited to evaluation of REMS without consideration of other potential scoring systems. However, prior studies have demonstrated that REMS provides comparable or superior prediction of hospital outcomes when comparing a number of available scoring systems including National Early Warning System, MEWS, Vitalpac Early Warning Score, Worthing Physiological Scoring System, Triage Early Warning Score, and the Prehospital Index 14 . The REMS also does not require a body temperature measurement, which is not consistently recorded in the prehospital setting 28–30 …”

Section: Limitationsmentioning

confidence: 99%

“…A number of studies have evaluated the value of acuity scores for the general EMS patient population. A recent comparison of the predictive value for hospital mortality of National Early Warning Score 2, Modified Early Warning Score (MEWS), Vitalpac Early Warning Score, Worthing Physiologic Scoring System, Triage Early Warning Score, Prehospital Index, and Rapid Emergency Medicine Score (REMS) modified for trauma found no statistical difference in the ability to predict mortality among the scores 14 . The REMS has proven valuable for predicting ED mortality 15,16 and, when measured during initial EMS evaluation, is able to predict ED disposition (discharge, hospital admission, ED death).…”

Section: Introductionmentioning

confidence: 99%

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Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Bourn¹,

Crowe²,

Fernández

et al. 2021

JACEP Open

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Objective The Rapid Emergency Medicine Score (REMS) has not been widely studied for use in predicting outcomes of COVID‐19 patients encountered in the prehospital setting. This study aimed to determine whether the first prehospital REMS could predict emergency department and hospital dispositions for COVID‐19 patients transported by emergency medical services. Methods This retrospective study used linked prehospital and hospital records from the ESO Data Collaborative for all 911‐initiated transports of patients with hospital COVID‐19 diagnoses from July 1 to December 31, 2020. We calculated REMS with the first recorded prehospital values for each component. We calculated area under the receiver operating curve (AUROC) for emergency department (ED) mortality, ED discharge, hospital mortality, and hospital length of stay (LOS). We determined optimal REMS cut‐points using test characteristic curves. Results Among 13,830 included COVID‐19 patients, median REMS was 6 (interquartile range [IQR]: 5‐9). ED mortality was <1% (n = 80). REMS ≥9 predicted ED death (AUROC 0.79). One‐quarter of patients (n = 3,419) were discharged from the ED with an optimal REMS cut‐point of ≤5 (AUROC 0.72). Eighteen percent (n = 1,742) of admitted patients died. REMS ≥8 optimally predicted hospital mortality (AUROC 0.72). Median hospital LOS was 8.3 days (IQR: 4.1‐14.8 days). REMS ≥7 predicted hospitalizations ≥3 days (AUROC 0.62). Conclusion Initial prehospital REMS was modestly predictive of ED and hospital dispositions for patients with COVID‐19. Prediction was stronger for outcomes more proximate to the first set of emergency medical services (EMS) vital signs. These findings highlight the potential value of first prehospital REMS for risk stratification of individual patients and system surveillance for resource planning related to COVID‐19.

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Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Bourn¹,

Crowe²,

Fernández

et al. 2021

JACEP Open

View full text Add to dashboard Cite

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“…Of the 15 included studies, 8 were conducted in the ED (27)(28)(29)(30)(31)(32)(33)(34), and 7 in the prehospital setting (11,(35)(36)(37)(38)(39)(40). Nine studies were prospective cohort (28, 30-34, 36-38), ve were retrospective cohort (11,27,29,35,39), and one study followed a pragmatic clinical trial design (40). In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34).…”

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

“…In the ED setting, all studies except one examined the use of MEWS (34), with two reporting on NEWS (29,34). In the pre-hospital setting, ve articles assessed NEWS2 (36-40) and three used NEWS (11,35,40). Overall, the meta-analysis included 7,556 and 71,658 patients from the ED and pre-hospital settings, respectively.…”

Section: Characteristics Of Articles Includedmentioning

confidence: 99%

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Guan

Lee

Begg

et al. 2021

Preprint

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Background: It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration when applied in the emergency department (ED) or pre-hospital setting. Methods: This systematic review and meta-analysis assessed the predictive abilities of five commonly used EWS scores: National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS) and Cardiac Arrest Risk Triage (CART). Outcomes of interest included admission to ICU, up-to-≥3-day and 30-day mortality. Pooled estimates were calculated using DerSimonian and Laird random-effects models, constructed by type of EWS score, cut-off points, outcomes, and study setting. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-regressions investigated between study heterogeneity. Funnel plots tested for publication bias. Results: A total of 11,565 articles was identified, of which 15 were included. Eight and seven articles conducted in the ED and pre-hospital settings, respectively. In the ED, MEWS and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (Confidence Interval (CI) 2.35–6.99) to 6.48 (95% CI 1.83–22.89), p = 0.757. The ability of MEWS (cut-off point ≥ 3) to predict ICU admission had a similar pooled DOR of 5.54 (95% CI 2.02–15.21). In the pre-hospital setting, EWS scores failed to predict 30-day mortality. Using high cut-off points of 5, 7, or 9, their predictability improved when assessing up-to-≥3-day mortality with DOR ranging from 11.60 (95%, CI 9.75–13.88) to 20.37 (95% CI 13.16–31.52).Publication bias was not detected. Participants’ age explained 92% of between-study variance. Conclusion: EWS scores’ predictability of clinical deterioration improves when applied on patient populations that are already in the ED or hospital. The high thresholds used and the scores’ failure to predict 30-day mortality make them less suited for use in the pre-hospital setting.

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Association of Prehospital Oxygen Saturation to Inspired Oxygen Ratio With 1-, 2-, and 7-Day Mortality

et al. 2021

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Key Points Question Can the prehospital ratio of oxygen saturation measured by pulse oximetry (Sp o 2 ) to fraction of inspired oxygen (F io 2 ) be used to model early in-hospital mortality? Findings Data from 3606 patients were analyzed in a prognostic study. The Sp o 2 to F io 2 ratio had a statistically significant area under the curve of 0.890 for the prediction of 2-day mortality. Meaning This study suggests that the prehospital Sp o 2 to F io 2 ratio allows for the identification of patients at risk of in-hospital deterioration.

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The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study

Cited by 20 publications

References 36 publications

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

Initial prehospital Rapid Emergency Medicine Score (REMS) to predict outcomes for COVID‐19 patients

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

Association of Prehospital Oxygen Saturation to Inspired Oxygen Ratio With 1-, 2-, and 7-Day Mortality

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