Top

Published in:

Open Access 01-12-2023 | Emergency Medicine | Research

The utility of the Rapid Emergency Medicine Score (REMS) compared with three other early warning scores in predicting in-hospital mortality among COVID-19 patients in the emergency department: a multicenter validation study

Authors: Onlak Ruangsomboon, Nutthida Phanprasert, Supawich Jirathanavichai, Chanokporn Puchongmart, Phetsinee Boonmee, Netiporn Thirawattanasoot, Thawonrat Dorongthom, Nattakarn praphruetkit, Apichaya Monsomboon

Published in: BMC Emergency Medicine | Issue 1/2023

Abstract

Background

Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes of COVID-19 in the Emergency Department (ED), including the quick Sequential Organ Failure Assessment (qSOFA), the Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has not been widely validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of qSOFA, MEWS, and NEWS for predicting mortality in emergency COVID-19 patients.

Methods

We conducted a multi-center retrospective study at five EDs of various levels of care in Thailand. Adult patients visiting the ED who tested positive for COVID-19 prior to ED arrival or within the index hospital visit between January and December 2021 were included. Their EWSs at ED arrival were calculated and analysed. The primary outcome was all-cause in-hospital mortality. The secondary outcome was mechanical ventilation.

Results

A total of 978 patients were included in the study; 254 (26%) died at hospital discharge, and 155 (15.8%) were intubated. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.771 (95% confidence interval (CI) 0.738, 0.804)), which was significantly higher than qSOFA (AUROC 0.620 (95%CI 0.589, 0.651); p < 0.001), MEWS (AUROC 0.657 (95%CI 0.619, 0.694); p < 0.001), and NEWS (AUROC 0.732 (95%CI 0.697, 0.767); p = 0.037). REMS was also the best EWS in terms of calibration, overall model performance, and balanced diagnostic accuracy indices at its optimal cutoff. REMS also performed better than other EWSs for mechanical ventilation.

Conclusion

REMS was the early warning score with the highest prognostic utility as it outperformed qSOFA, MEWS, and NEWS in predicting in-hospital mortality in COVID-19 patients in the ED.

Available only for authorised users

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–33. https://doi.org/10.1056/NEJMoa2001017.CrossRefPubMedPubMedCentral

Sahu KK, Mishra AK, Lal A. Trajectory of the COVID-19 pandemic: chasing a moving target. Ann Transl Med. 2020;8:694. https://doi.org/10.21037/atm-20-2793.CrossRefPubMedPubMedCentral

Guo F, Qin Y, Fu H, Xu F. The impact of COVID-19 on Emergency Department length of stay for urgent and life-threatening patients. BMC Health Serv Res. 2022;22(1):696.CrossRefPubMedPubMedCentral

Bouillon-Minois JB, Raconnat J, Clinchamps M, Schmidt J, Dutheil F. Emergency Department and Overcrowding during COVID-19 outbreak; a letter to editor. Arch Acad Emerg Med. 2021;9(1):e28.PubMedPubMedCentral

Churpek MM, Zadravecz FJ, Winslow C, et al. Incidence and prognostic value of the systemic inflammatory response syndrome and organ dysfunctions in ward patients. Am J Respir Crit Care Med. 2015;192:958–64.CrossRefPubMedPubMedCentral

Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA. 2017;317:301–8.CrossRefPubMed

Singer M, Deutschman CS, Seymour CW, et al. The Third International consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.CrossRefPubMedPubMedCentral

Saeed K, Wilson DC, Bloos F, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care. 2019;23(1):40.CrossRefPubMedPubMedCentral

Yu M, Huang B, Liu P, Wang A, Ding W, Zhai Y, et al. Detection of deteriorating patients after Whipple surgery by a modified early warning score (MEWS). Ann Transl Med. 2019;7:574. https://doi.org/10.21037/atm.2019.09.24.CrossRefPubMedPubMedCentral

10.

Brink A, Alsma J, Verdonschot RJCG, et al. Predicting mortality in patients with suspected sepsis at the Emergency Department; a retrospective cohort study comparing qSOFA, SIRS and National Early warning score. PLoS ONE. 2019;14:e0211133.CrossRefPubMedPubMedCentral

11.

Xie X, Huang W, Liu Q, Tan W, Pan L, Wang L, et al. Prognostic value of modified early warning score generated in a chinese emergency department: a prospective cohort study. BMJ Open. 2018;8e24120. https://doi.org/10.1136/bmjopen-2018-024120.

12.

Olsson T, Lind L. Comparison of the rapid emergency medicine score and APACHE II in nonsurgical emergency department patients. Acad Emerg Med. 2003;10(10):1040–8.CrossRefPubMed

13.

Ruangsomboon O, Boonmee P, Limsuwat C, Chakorn T, Monsomboon A. 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. BMC Emerg Med. 2021 Jan 7;21(1):2. https://doi.org/10.1186/s12873-020-00396-x.

14.

Baker KF, Hanrath AT, van der Schim I, Kay LJ, Back J, Duncan CJ. National early warning score 2 (NEWS2) to identify inpatient COVID-19 deterioration: a retrospective analysis. Clin Med (Lond). 2021 Mar;21(2):84–9. https://doi.org/10.7861/clinmed.2020-0688. Epub 2021 Feb 5.

15.

Su Y, Ju MJ, Xie RC, Yu SJ, Zheng JL, Ma GG et al. Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19. Front Med (Lausanne). 2021 Feb 1;7:624255. https://doi.org/10.3389/fmed.2020.624255.

16.

Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I et al. Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021 Mar 2;11(3):170. https://doi.org/10.3390/jpm11030170.

17.

Colombo CJ, Colombo RE, Maves RC, Branche AR, Cohen SH, Elie MC et al. Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort.Crit Care Explor. 2021 Jul13;3(7):e0474. https://doi.org/10.1097/CCE.0000000000000474.

18.

Hu H, Yao N, Qiu Y. Predictive Value of 5 Early Warning Scores for Critical COVID-19 Patients.Disaster Med Public Health Prep. 2020 Sep9:1–8. https://doi.org/10.1017/dmp.2020.324. Epub ahead of print.

19.

Carr E, Bendayan R, Bean D, Stammers M, Wang W, Zhang H et al. Evaluation and improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study. BMC Med. 2021 Jan 21;19(1):23. https://doi.org/10.1186/s12916-020-01893-3.

20.

Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019–2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China. Intensive Care Med. 2020;46:357–60. https://doi.org/10.1007/s00134-020-05954-2.CrossRefPubMedPubMedCentral

21.

Swiss Society of Intensive Care Medicine. Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs). Swiss Med Wkly. 2020;150:w20227. https://doi.org/10.4414/smw.2020.20227.CrossRefPubMed

22.

Yan L, Wang W, Luo R, Hu H. Five rapid scoring systems for predicting the mortality of severe novel coronavirus disease patient. Am J Emerg Med. 2021 Jul;45:611–2.

23.

Kaeley N, Mahala P, Kabi A, Choudhary S, Hazra AG, Vempalli S. Utility of early warning scores to predict mortality in COVID-19 patients: a retrospective observational study. Int J Crit Illn Inj Sci. 2021 Jul-Sep;11(3):161–6.

24.

Hu H, Yao N, Qiu Y. Comparing Rapid Scoring Systems in Mortality Prediction of critically ill patients with Novel Coronavirus Disease. Acad Emerg Med. 2020;27(6):461–8. https://doi.org/10.1111/acem.13992.CrossRefPubMedPubMedCentral

25.

Martín-Rodríguez F, Martín-Conty JL, Sanz-García A, Rodríguez VC, Rabbione GO, Cebrían Ruíz I, Oliva Ramos JR, Castro Portillo E, Polonio-López B. Enríquez de Salamanca Gambarra R, Gómez-Escolar Pérez M, López-Izquierdo R. Early Warning Scores in Patients with Suspected COVID-19 Infection in Emergency Departments. J Pers Med. 2021 Mar 2;11(3):170.

26.

Puchongmart C, Boonmee P, Jirathanavichai S, Phanprasert N, Thirawattanasoot N, Dorongthom T, Monsomboon A, Praphruetkit N, Ruangsomboon O. Clinical factors associated with adverse clinical outcomes in elderly versus non-elderly COVID-19 emergency patients: a multi-center observational study. Int J Emerg Med. 2023 Feb 22;16(1):11.

Title: The utility of the Rapid Emergency Medicine Score (REMS) compared with three other early warning scores in predicting in-hospital mortality among COVID-19 patients in the emergency department: a multicenter validation study
Authors: Onlak Ruangsomboon
Nutthida Phanprasert
Supawich Jirathanavichai
Chanokporn Puchongmart
Phetsinee Boonmee
Netiporn Thirawattanasoot
Thawonrat Dorongthom
Nattakarn praphruetkit
Apichaya Monsomboon
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Emergency Medicine
COVID-19
Published in: BMC Emergency Medicine / Issue 1/2023
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-023-00814-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The utility of the Rapid Emergency Medicine Score (REMS) compared with three other early warning scores in predicting in-hospital mortality among COVID-19 patients in the emergency department: a multicenter validation study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Australian emergency department care for older adults diagnosed with low back pain of lumbar spine origin: a retrospective analysis of electronic medical record system data (2016–2019)

Improvement in the diagnosis and practices of emergency healthcare providers for heat emergencies after HEAT (heat emergency awareness & treatment) an educational intervention: a multicenter quasi-experimental study

Changes in trauma-related emergency medical services during the COVID-19 lockdown in the Western Cape, South Africa

Patient-reported side effects and satisfaction of pre-hospital analgesia with low-dose esketamine: a cross-sectional study

Current situation and needs analysis of medical staff first aid ability in China: a cross-sectional study

Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)